
Glass HQ 4^5 

Rnnk ."? 31 

1 3 o 7 o^ 



REPORT OF INVESTIGATIONS 



GENERAL FINDINGS AND RECOMMENDATIONS 



OF THF 



LEGISLATIVE COMMISSION TO INVESTIGATE VARIOUS CHARITABLE 

INSTITUTIONS. . ' 



STATE OF PENNSYLVANIA. 



HARRISBURG, PA.: 

HARRISBURG PUBLISHING CO., STATE PRINTER. 
1907. 



REPORT OF INVESTIGATIONS 



AND 



/Of 



GENERAL FINDINGS AND RECOMMENDATIONS 



OF THE 



LEGISLATIVE COMMISSION TO INVESTIGATE 
VARIOUS CHARITABLE INSTITUTIONS. 



STATE OF PENNSYLVANIA. 



HARRISBURG, PA.: 

HARRISBURG PUBLISHING CO., STATE PRINTER. 

1907. 



11 



£L 



m^Y 23 1907 
D. OF D. 







lr 



^ 



■ \r i 



;•> 



(2) 



REPORT OF THE COMMISSION. 



To the Honorable the Officers and Members of the Senate and House 
of Representatives of the State of Pennsylvania: 

Your Commission appointed under a joint resolution passed by 
your honorable bodies on April 18th, 1905, entitled "A joint reso- 
lution creating a Commission to investigate various charitable in- 
stitutions" beg leave to submit our report in which we find 

1. The housing or custodial care of the insane in the various 
institutions totally inadequate and inefficient to meet present con- 
ditions. This largely arises from the ancient construction of many 
of the buildings and their overcrowded condition, 

2. In the treatment and care administered to nearly 15,000 in- 
mates those who are responsible therefor have not kept apace with 
the highest medical skill and science. 

3. The laws and decisions fixing the responsibility of relatives 
and others for the support of inmates have not been enforced by 
the authorities in whom the power is vested to act. In consequence 
of this neglect the Counties have not been reimbursed in many 
thousands of cases and the State has not been reimbursed for 
moneys amounting to hundreds of thousands of dollars paid for 
their maintenance in the first instance and which should have been 
repaid by the estates of inmates or relatives responsible under the 
law. 

4. Your Commission recommends the passage of proposed acts 
hereto attached to remedy these and other evils, namely: 

A bill to provide for the reorganization of the State Board of 
Charities and to invest authority for the purpose of more thorough 
control and supervision. 

A bill to provide for the collection from the estates of inmates 
in charitable institutions or from the estates of relatives who are 
liable for the same to reimburse the State and the Counties for the 
expenses of their maintenance. 

A bill to permit the employment of inmates of institutions for 
the insane, feeble minded and epileptics, to manufacture articles 
and products used in such institutions and for the interchange of 
such products and articles with similar institutions of the State. 

A bill to provide for the expeditious appointment of guardians 
of the estates of the insane and mentally defective. 

"(8) 



A bill to provide for the amendment of the act regarding the 
commitment of inebrates and others addicted to the use of drugs, 
etc., to State hospitals for the care of the insane so as to transfer 
the power of commitment from magistrates and justices of the 
peace to the Courts of the Quarter Sessions. 

Appended is a review of the work of your Commission with de- 
tailed reports regarding the several institutions visited and recom- 
mendations for the improvement of existing conditions. 

The Commission as originally appointed consisted of the fol- 
lowing: 

Honorable Henry F. Walton, Philadelphia. 
Honorable William P. Snyder, Spring City. 
Honorable Cyrus E. Woods, Greensburg. 
Honorable John S. Fisher, Indiana. 
Honorable Myron Matson, McKean. 
Honorable Edward E. Beidleman, Harrisburg. 
Honorable James F. Woodward, McKeesport. 
Honorable Robert B. Scott, M. D., Philadelphia. 

Upon the death of Honorable Myron Matson, Honorable Milton 
Heidlebaugh of Lancaster was appointed by the President Pro Tern. 
of the Senate to succeed him. 

The first meeting of the Commission was held on December 8th, 
1906, in the office of Hon. Henry F. Walton, 608 Real Estate Trust 
Building, in the City of Philadelphia, and organized by the election 
of the following officers: 

Henry F. Walton, Chairman. 
Mr. George J. Brennan, Secretary. 
R. B. Scott, Treasurer. 

John R. K. iScott, Esq., of the City of Philadelphia, Attorney for 
the Commission. 

Under a resolution passed at this meeting the President was 
authorized to appoint a Secretary and such other employes as neces- 
sary to carry on the work of the Commission. 

Your Commission then and there immediately proceeded to take 
testimony, having summoned to appear before the Commission J. 
Nicholas Mitchell, M. D., Secretary of the Lunacy Committee of the 
Board of Charities of the City of Philadelphia. 

Subsequent meetings as will be shown by the testimony and min- 
utes were held at various times for the purpose of taking testimony, 
and also 'for the purpose of examining and inspecting the various 
institutions of our State. It was the rule of your Commission to 
usually meet in the institution itself, where the testimony of the 



Superintendent, physicians, attendants, stewards, nurses, inmates 
and others, as deemed advisable, was taken under oath. This was 
immediately followed by a careful inspection and examination of the 
institution and its inmates. 

It will be found that we have endeavored in this report to give, 
first, a statement of facts taken from the evidence, what we have 
seen and what we have heard. This is followed by a statement con- 
taining our comments and recommendations upon certain particular 
facts therein. We thus endeavor i.o set forth a statement of gen- 
eral findings and recommendations. 

The report constitutes an investigation into the management, care 
and treatment of the insane incarcerated in all the insane institu- 
tions wholly or partially maintained by State appropriations which 
are as follows: 

The Pennsylvania State Lunatic Hospital, Harrisburg. 
4 State Hospital for the Insane of the Southeastern District of Penn- 
sylvania Norristown. 

^State Hospital for the Chronic Insane, Wernersville. 
v State Hospital for the Insane, Danville. ■ 

v State Hospital for the Insane, Warren. 

v Western Pennsylvania Hospital for the Insane, Dixmont. 

i State Institution for Feeble-Minded of Western Pennsylvania, 
Polk. 

v Pennsylvania Training School for Feeble-Minded Children, Elwyn. 

The State Hospital for the Insane at Warren; the Pennsylvania 
State Lunatic Hospital at Harrisburg; the *. State Hospital for the in- 
sane of the Southeastern District of Pennsylvania at Norristown, the 
State Hospital for the Insane at Danville, and the Western Pennsyl- 
vania Hospital for the Insane at Dixmont were originally built on the 
monasterial or Kirkbridge plan. These buildings are three or four 
stories in height and consist of a series of halls running from dif- 
ferent points in the main structure or Administration building, with 
a line of rooms on both sides of the hall. These halls are lighted 
by windows in both ends and from such light as might be reflected 
through the windows in each of the rooms, provided the door lead- 
ing into the hall is open. The width of these halls is about twelve 
feet, and the length from 200 to 250 feet. The rooms average in 
size from eight feet ten inches by a ten foot ceiling, to nine feet 
twelve inches, with a ten foot ceiling. Lavatories are constructed 
at both ends of the corridors. 

This constitutes a description of the original plan and method of 
construction. 

We will now take up for discussion these five institutions in their 
order. 



STATE HOSPITAL FOR THE INSANE, 
WARREN. 



GROUNDS: 

Acreage, 650 acres. 

Under cultivation, 307 acres. 

Not under cultivation, 343 acres. 

BUILDINGS: Number, 11. 

Occupied by employees, storehouses, laundry, farm purposes. 
Three buildings are occupied by patients. 

Four buildings in course of construction and to be occupied by 
patients. 
Number of stories, two to four. 

Sizes of halls, main building, average 212 feet long, 12 feet wide. 
Main building, single rooms, 8 feet 10 inches by 10 feet. 
Main building, dormitories, 16 feet 1 inch, by 16 feet. 

BUILDING MATERIAL USED IN CONSTRUCTION: 

Main building is of stone. 

Other buildings of brick with the exception of the Hygeia build 
ing, which is of wood. 

LIGHTING: 

All buildings are lighted by daylight through outside windows. 

No shafts. 

At night by electricity. 

DINING ROOMS: 

24. Size 17 by 30 feet. Located in Main building. 

One at Farm Colony 57 feet by 23 feet. 

New buildings have large dining room capacity. 

CAPACITY: 

20 at Hygeia and 100 at Farm. 

Main building averages 36. 

New annex accommodates 100. 

Male and female patients do not dine together. 

Male and female nurses do not dine together. 



YARDS: 

There are 4 enclosed yards, one acre, each for exercise of untidj 
patients. 

Large grounds for the exercise of the better class. 

FIRE PROTECTION: 

Main buildings fire proof with the exception of the roof which can 
be flooded with live steam at a moment's notice. 
Main and other buildings connected with hose. 
Fire plugs at intervals near buildings. 

VENTILATION : 

Is forced by two twelve feet fans. 

CAPACITY: 

716. 

With new buildings complete, 9S2. 

POPULATION: 

January 1st, 1907, 1,180. 
Private patients, 77. 

PER CAPITA COST OF MAINTENANCE: 

13.8481 per week. 

PERCENTAGE OF DEATHS: 

During year 1906, 6 per cent. 

NUMBER DISCHARGED, 1906, 169. 

Restored, 58; improved, 91; unimproved, 20. Total, 169. 

NUMBER OF PATIENTS SICK, 29. 

NUMBER OF PATIENTS CONFINED TO THEIR BED, 106. 

SALARIES: 

Superintendent's salary, $3,000. 

NUMBER OF PHYSICIANS ON STAFF AND SALARIES: 

First assistant, f 1,000; two assistants at |900 each; two assistants 
at |800 each. 



NURSES AND ATTENDANTS: 

Male, number 51; salaries $16 to $30. 

Female, number 49; salaries $14 to $30. 

Day nurses are on duty from 6 A. M. to 9 :30 P. M. with the exeep 
tion of an hour daily, time for meals. Half a day each week and 
every third 'Sunday off. One week's vacation every six months. 

Nine nurses on duty from 9:30 P. M. to 6 A. M. 

'Same vacation as day nurses. 

Male nurses eat and sleep in wards, but have meals different 
hours from patients. 

Female nurses sleep in detached Nurses Home and eat in ward 
dining rooms at different hours from patients. 

NUMBER OF PATIENTS EMPLOYED, 717. 

EMPLOYMENTS: 

Ward work, farm work, laundry, kitchen, outside work on im- 
provements, sewing, basketry, art class and gardening. 

Approximately 61 per cent, employed. 

Nothing manufactured except fancy articles and things for their 
own consumption. 

WATER SUPPLY: 

Water supply from driven wells 69 feet below surface. 

HEATING: 

Indirect radiation with vacuum system. 

SEWAGE: 

Gravity system empties into current of Conewago Creek, one mile 
from buildings. 

RECEIVING WARD AND CONVALESCENT BUILDINGS: 

There is no special receiving ward, but an effort is made to classify 
the patients according to condition upon admission. 

The Convalescent Home for Women is in a separate building 
accommodating 17 patients. When addition is furnished capacity 
will be doubled. 

The Superintendent of this institution is Morris S. Guth, M. D. 
He became connected with the same in 1880. He was graduated 
from the University of Pennsylvania in 1876, and has made a spec- 
ialty of the treatment of the insane, giving the subject his whole 
time and attention since his graduation. 



9 

The institution was established by an act of the Legislature, ap 
proved August 14th, 1873, P. L. 333. 

Eleven counties comprise the district from which it was to receive 
patients. 

There are connected with this institution features that we cannot 
commend. For instance, it was the same old method of construc- 
tion here that we find in so many of the other institutions. The 
Monasterial system was in vogue at the time of its construction 
to a great extent. Long halls are prominently in evidence. The 
old wards have been somewhat improved by the placing of windows 
in the centers of some of the halls, giving additional light to that 
furnished by the windows in either end. Wherever it has been 
convenient to make these changes, it has been done, but as the 
original architectural structure was faulty, it is a work of time 
and thought that the most beneficial changes can be effective. 

Compared with other institutions of the State which are built 
upon the ancient plans, we consider this fartherest advanced in 
improvement, and the many features and additions which have been 
added, such as the Hygeia building, Amusement building, which 
contains baths, the Farm Colony building, are of such a character 
that we can commend them to other institutions as examples to 
be followed. 

This institution has a training school for nurses. 

It has many features which are in accordance with the modern 
trend of scientific thought as it pertains to the treatment of the 
diseases of the mind — for instance, the receiving w T ard for incipient 
cases of insanity are, in our opinion, most commendable features, 
It enables the physician in charge to make an exact and complete 
diagnosis of the form of insanity from which the individual is suf- 
fering and thus he is enabled to place the patient in the proper 
department of the institution. This i not true of many other in- 
stitutions, and we emphasize this particularly, as it is important 
from the standpoint of improvement and final recovery. Unless 
the patient's particular kind of form of insanity is exactly diagnosti- 
cated, it prevents the Superintendent from placing him or her under 
the proper surroundings and environment, and consequently pre- 
vents the proper medicinal treatment, thus retarding final con- 
valescence which is the supreme object sought for in every case of 
dementia. 

The Convalescent Home for Women is most highly beneficial and 
we commend it most thoroughly as one of the best features we 
have seen in any of the institutions of the State. There, when 
evidence of improvement appears in individual cases, they are trans- 
ferred to this Convalescent Home, and it appears from reports made 



10 

by the institution officials that the different patients capable of 
understanding view with pleasure the time of their placement in 
this highly beneficial department. 

The crowding that we found in all of the institutions exists here, 
the room being inefficient for the accommodation of their vast pop- 
ulation. 

There seems to be a general desire of the management to take 
every advantage that can be afforded for the improvement of the 
institution by making it as modern as possible with the money 
furnished. 

One attractive thing at Warren — and which served to give the 
place a comfortable and homelike appearance — was the strips of 
carpet running through the halls and in some of the rooms. In 
fact, we saw more carpet on the floor of this institution than any 
other visited. We highly commend its use. Another feature were 
the drapped curtains which were found hung at many of the win- 
dows. The introduction of these furnishings not only as we have 
said beautified and gave the place a homelike appearance, but they 
added materially to the welfare, treatment and the comfort 
of the patients. Other institutions should be made to follow this 
example. 

While we know that carpets as a rule are deprecated, viewed 
from a sanitary standpoint, in public institutions, at the same time, 
in the modern well constructed institution which is built upon home 
plans, we think it admits of this kind of furnishing because of the 
homelike appearance it gives to the surroundings. 

The testimony shows that great difficulty is encountered here in 
the employment and retaining of nurses, especially male nurses. 

Although the Act of July 5th, 1883, P. L, 179, provides that the 
Superintendent shall advertise for two successive weeks in three 
newspapers of general circulation, commencing on the first Monday 
in April of each year, for bids to furnish needed supplies, and award 
the contract to the lowest bidder for the year beginning June 1st 
next ensuing, the same is not complied with at this institution, but, 
on the contrary, blank schedules are sent to various merchants or 
manufacturers, who produce the various commodities required, and 
the contract awarded on bids received in this way. This we cannot 
commend, as we believe the Act should be strictly complied with. 

The sewage is drained into the Conewago Creek, about 
half a mile below the institution. This system we cannot 
commend, and sooner or later a new method for the disposing of 
the same will have to be adopted. 



11 



PENNSYLVANIA STATE LUNATIC HOSPITAL, 

HARRISBURG. 



GROUNDS: 

Acreage, 420.81. 

Under cultivation, about 205. 

Not under cultivation, 215.81. 

BUILDINGS FOR PATIENTS: 

Number, eight, viz: 

Number of stories, two 1-story; five 2-story; one 4-story, divided 
into 19 wards. Used for the accommodation of patients. 

Halls are 12 feet wide; single rooms 9 feet by 12 feet. 

Material used in construction is red brick, iron, tile, concrete and 
wood covered with iron. 

ON MALE SIDE: 

One building for reception of patients (2 stories, 2 wards). 
One building for conAalescent patients (2 stories, 2 wards). 
One building for chronic patients (2 stories, 2 wards). 
One building for dangerous and destructive patients (2 stories, 
2 wards). 

One infirmary for male and female patients (1 story, 4 wards). 

ON FEMALE SIDE: 

One building for chronic patients (2 stories, 2 wards). 

One 4-story building, 4 wards, corridors therein, 130 feet by 10 
feet by 10 feet; rooms, 8 feet by 10 feet. 

The first and second stories of this building are occupied by 
patients, the third and fourth stories assigned to nurses. 

The same sized buildings on the male side is partly dismantled, 
but is used for the housing of male nurses. 

One building for matron and steward's quarters, kitchen, store 
rooms, ice plant, bake house, cold storage and butcher shop com- 
bined (one and two story). 

One laundry, machine shop, electric light plant and boiler house 
(one building, 3-story). Third story used for sleeping quarters for 
employees. 



12 

One carpenter and paint shop (one building, 1 story). 

One tailor, shoemaker and mattress repair shop, marking room, 
barber shop and smoking room for employees (2-story); second story 
used for laboratory and sleeping room for employees. 

Three barns, one potato storage shed, one machine storage shed, 
one plot of hot houses with hot water boilerhouse — about 2,000 
square feet. 

Five 2-story farm houses. 

LIGHTING: 

All rooms are lighted by electricity as well as the buildings. 

DINING ROOMS: 12. 

Located in various buildings and vary in size from 12 by 10 feet, 
to 120 by 40 feet. 

Their capacity is from 16 to 200. 

Male and female patients dine together in one dining room only. 

Male and female nurses dine together in one dining room only. 

ENCLOSED YARD FOR PATIENTS: 

One for women only, 300 by 150 feet, to be disused a:s soon as 
building operations are finished. 

FIRE PROTECTION: 

Hose on reel in each ward, fire extinguishers in each ward; hose 
card and hose to be attached to outside hydrants by engineer in 
charge. 

SYSTEM OF VENTILATION: 

By extraction — air shafts enclosing heat coils. 

NORMAL CAPACITY: 806. 

PRESENT POPULATION: 509 males; 497 females. 
Private patients, four males; nine females, included in above. 

PER CAPITA COST OF MAINTENANCE: $3.75 per week. 
DEATH RATE: 

Percentage of deaths, 1906, 7 per cent. 



13 
NUMBER OF DISCHARGES, 100(>: 

Improved — 39 men; 16 women. 
Restored — 15 men; 43 women. 

NUMBER OF PATIENTS SICK: 93 men; 112 women. 

NUMBER OF PATIENTS CONFINED TO THEIR BEDS: 98 men; 
112 women. 

SALARY OF SUPERINTENDENT: $5,000 per annum. 

NUMBER OF PHYSICIANS ON STAFF AND SALARIES: 

One at $1,500; three at $1,000 each per annum. 

NURSES: 

Male, number. 52; salary, $18 to $35. 

Female, number 52; salary, $18 to $25. 

Hours employed both male and female nurses, 5 A. M. to 9 P. M. 

Male nurses sleep and eat. some in wards and some separate 
buildings. 

Female nurses sleep and eat, some in wards and some in separate 
buildings. 

NUMBER OF PATIENTS EMPLOYED AND CHARACTER OF 
EMPLOYMENT : 

Coal heavers, machinists' assistants, electrician's assistant, gard- 
eners, farmers, laborers, assisting in care of wards, laundry, sewing 
room, shoe shop, mattress room and kitchen. Thirty-four per cent, 
male patients employed; 31 per cent, female patients employed. 

GOODS MANUFACTURED: 

A small amount of clothing and all mattresses are manufactured. 

WATER SUPPLY: 

Filtered water from Susquehanna River, refiltered before using 
by hospital filter plant. 

HEATING SYSTEM : 

Steam (Webster Vacuum System). 

SEWAGE: 

L^nderground gravity drains. The sewage empties into intercept 
ing main of City of Harrisburg. 



14 

NATURE AND KIND OF TREATMENT ACCORDED PATIENTS: 

Medicinal, moral, mechanical, viz : by medicine, by mental influence, 
by electricity, massage, water, etc. 

THERE IS A CONVALESCENT AND RECEIVING WARD IN 
THE INSTITUTION. 

Receiving ward accommodates 40 patients. 

Convalescent ward accommodates 88 patients. 

The 4-story building above noted is an old antiquated structure 
with lath and plaster, heat and ventilating flues; so dangerous 
that ten years ago the patients were removed from the third and 
fourth stories, and now occupy only the first and second stories. 
The third and fourth stories are used for attendants and employees. 

The "normal capacity" does not include 150 patients cared for in 
temporary building erected under Act 1905, which should 
not be classed as part of "normal capacity", as they were built 
only to give temporary relief, and will have fulfilled their require- 
ments as soon as new buildings are completed. 

LIST OF WORK DONE IN MATTRESS AND SHOE ROOM FOR 
YEAR 1906: 

Mattresses worked over, 155 

Mattresses (new) 53 

Blankets quilted, 36 

Canvas mattresses made, 14 

Clothes bags, 105 

Pillows, 194 

Tick aprons, £(8 

Horse covers, 18 

Canvas dresses, 43 

Canvas dresses repaired, • 47 

Mits made, 29 pairs 

Box mattresses, 6 

Double mattresses, 2 

Blinds (new), 161 

Blinds (repaired), 120 

Carpets made and laid, 14 

Lounges upholstered, 9 

Shoes soled, 76 pairs 

Shoes repaired, 97 pairs 

Harness, 15 sets 

Halters, 20 pairs 

Storm sheets made 2 



15 

Saddle pad, 1 

Hitching straps, 6 

Mail pouch, 1 

Over check, 2 

Coffee bags, 3 

Couch covers made, 4 

Lace curtains hemmed, 12 

Sewing machine repaired, 10 

The Superintendent of the Pennsylvania State Lunatic Hospital, 
at Harrisburg, is Dr. H. L. Orth, who became connected with the 
institution in 1891. He graduated from the University of Pennsyl- 
vania in 18G6 and has made a. specialty of the treatment of the in- 
sane and given the subject his whole time and attention during the 
past twenty years. 

This institution was created by an Act of Assembly approved 
April 14th, 1845, P. L. 440 and supplement approved April 11th, 1848. 

Sixteen counties comprise the district from which it was to re- 
ceive patients. 

The control of the institution is vested in a Board of Nine Trustees 
appointed by the Governor. 

The Pennsylvania State Lunatic Hospital, at Harrisburg, origin- 
ally constructed on the old Monast^rial plan, is the first institution 
in the State of which the Superintendent conceived the idea 
of making changes in accordance with modern thought and 
enterprise in caring for the insane. Part after part of the old 
buildings were destroyed and demolished and in their places were 
erected modern structures. This tearing down process has been 
going on until to-day four wards of the old building are left stand- 
ing and occupied. 

Here can be seen the great contrast between the old and the new 
method of custodial care and treatment. In so far as the improve- 
ments have gone the Superintendent has been better enabled to 
make the proper classification of his patients. 

The improvements here seem to have been steady and progressive 
and in our judgment there is very little to be criticized in connection 
with this institution. 

We cannot approve of the underground passageway which has 
been constructed to connect the buildings, and while this is true we 
are compelled to say that it is the best built and lighted subway 
of its kind that we have seen, and certainly an improvement on the 
old method of construction. 

There are still, however, many things to do along the line of gen- 
eral improvement. They are meagre and particular cases, but, 
summed up together, are important. 



16 

We found in this institution half a dozen inmates who were 
dressed in their under garments and stockings. We were in- 
formed by the Superintendent that the reason for this was that these 
men were violent patients and while so dressed considered them- 
selves sick and as such were very much greater subject to control. 
This may be possible. Of course we have no reason to take issue 
with his statement. At the same lime, we think that every means 
possible should be used to teach these inmates to wear clothes. 

. This institution complies with the Act of July 5th, 1883, P. L. 
179, which requires advertisements for bids to be inserted in news- 
papers for all supplies furnished. 

During the session of the Legislature of 1905 the Chairman of 
your Commission conceived the thought that in order to quickly 
relieve the overcrowded condition of these institutions temporary 
buildings might be constructed at little cost which could be used 
until the new, more substantial and permanent buildings were com- 
pleted, and when the same were finished and received, their patients, 
the use of the temporary buildings having filled their purpose so 
far as the institution is concerned, could have been removed to 
Mont Alto on the reservation owned by the State and where a camp 
for poor consumptives has been located. 

Appropriations for this purpose were made to the institutions 
at Norristown, Danville and Harrisburg. The Superintendent at 
Harrisburg was the only one that took advantage of the appro- 
priation and constructed this temporary building. We have in- 
spected it most carefully and are sure that it needs only to be 
seen to be commended. It to-day stands as one of the brightest 
spots in the midst of all the other buildings, being comfortable, 
clean and well ventilated, constructed with a line of windows on the 
two long sides it is filled with light and sunshine. 

Dr. Orth should be commended for carrying out the provisions 
of the Act of Assembly in reference to the erection of this tem- 
porary building. 

The sewage of this institution is drained into the city sewers, of 
Harrisburg. 



17 



STATE HOSPITAL FOR THE INSANE SOUTH- 
EASTERN DISTRICT OF PENNSYLVANIA, 
NORRISTOWN. 



GROUNDS: 

Number of acres, 563. 
Acreage under cultivation, 250. 
Acreage not under cultivation, 313. 

BUILDINGS: 

Total number of buildings used in care of male patients, 7. (Sec- 
tions 5, 6, 7, 8, 9, 11, and Hartranft Cottage for Consumptives.) 

These buildings are two stories in height and constructed of 
brick. Hartranft Cottage is two stories high and constructed of 
stone. The size of the halls in most of the sections is 136 feet long 
by 12 feet wide. 

In Section 8 the halls are 56 feet long and 12 feet wide. 

In Section 11 the day room is 37 by 74 feet and dormitories 72 by 
48 feet. / 

In Section 9 "The Infirmary,-' the dormitories are 79 by 38 feet. 

The day room, 30 by 88 feet. 

The smaller rooms for the accommodation of patients vary from 
7 to 10 feet, to 10 by 16 feet. 

The uses of the various buildings are as follows : 

SECTION 5: 

Lower floor accommodates a quiet and largely convalescent class 
of patients. 

SECTIONS: / 

Upper floor is used for receiving ward. 

TWO WARDS IN SECTION 6 are used for the Epileptics, the 
quieter class being down stairs, and the more untidy and dis- 
turbed class upstairs. The other two wards in Section 6 acre 
used for a mild chronic class of patients. 

SECTION 7, downstairs, is used for a somewhat less desirable class 
of chronic patients. The two upstairs wards in Section 7 are 
used for an untidy and unclean class of patients. 

2 



18 

SECTION 8 is devoted to the unruly and dangerous class of patients 
in the upstairs wards, while the lower floor is devoted to a 
somewhat less troublesome class of disturbed patients, many 
of whom work out of doors. 

SECTION 9 is the infirmary where all the physically sick are 
treated and where a number of the feeble old men are taken 
care of. 

SECTION 11 is devoted to a hardy working class of patients. 

THE HARTRANFT COTTAGE is devoted to the treatment of 
consumptives and has a capacity of 43 beds, occupied by 41 pat- 
ients. All rooms in which patients or attendants sleep have at 
least one window. The attendants' rooms and a few of the 
patients' rooms have individual electric lights. All buildings 
are lighted with electricity alone. There are sky lights in Sec- 
tion 9. 

MALE DINING ROOMS: 

There are eight dining rooms in the department for men, as fol- 
lows: 

One in Section 5. 

One in Section 6. 

One in 'Section 7. 

Two in Section 8. 

One in Section 9. 

One in Hartranft Cottage. 

One large General Refectory. 

The dining rooms vary in size, 23 by 21 feet in the regular section 
buildings to the large refectories which are 152 by 4G feet. 
The regular section dining rooms, such as in Section 5, accom- 
modate 28 patients. At the present time there are 578 patients 
eating in the large refectory. Some of the wards are so 
crowded that it is necessary to have two tables at each meal 
in order to feed all of the patients. 

The male and female patients do not dine together. 

The male and female nurses do not dine together. 

Total number of buildings used in care of female patients, 10. 
(Sections 1, 2, 3, 4, 10, 12, convalescent building, not yet oc- 
cupied Stinson Cottage for Consumptives, Farm Cottage and 
Nurses Home). 

Sections 1, 2, 3, 4, 10, 12, convalescent building for women, each 
two stories high and constructed of brick. Stinson Cottage 
for Consumptives (occupied by 22 patients) three stories high 
and constructed of stone (third floor occupied by nurses). 



19 

Cottage at Farm, for patients (occupied by 15 patients) three 

stories high and built of stone. 
Home for female nurses (rooms for 110 nurses) three stories 

high and built of brick. 
No patients occupy the third story of any of the three story 

buildings. 
The size of halls in most of the sections is 136 feet long by 12 feet 

wide. 

IN SECTION 1, the halls are 87 feet long and 12 feet wide with a 
cross hall 56 feet long and 12 feet wide. 

IN SECTION 12 tBe day room is 37 by 74 feet and the dormitories 
72 by 48 feet. 

IN SECTION 10. "The Infirmary", the day room is 30 by 88 feet 
and the dormitories 70 by 38 feet. 
The uses of the various buildings are as follows: 

SECTION ONE is used for a restless, noisy, violent class of patients 
in the upstairs wards, while the lower floor is devoted to a 
somewhat less troublesome class of disturbed patients. 

SECTION TWO is used for an untidy and unclean class of patiens 
upstairs and for a somewhat less desirable class of chronic 
patients downstairs. 

SECTION THREE, Wards A and C (downstairs) is used for a fairly 
quiet class of chronic patients. Ward B is used as a receiving 
ward for disturbed patients and Ward D is used for the care 
of the epileptics. 

SECTION FOUR, lower floor, accommodates a quiet class of patients, 
many of whom are convalescent. Upper floor, W r ard B, is used 
as a receiving ward for quiet cases. Ward D is used for a class 
of clean, quiet, somewhat feeble patients. 

SECTION TEN is given over to the care of those who are physically 
sick, the halt, the lame and the blind. 

SECTION TWELVE is devoted to a hardy working class of patients. 
Stinson Cottage is used for the isolation and treatment of con- 
sumptives. 

FARM COTTAGE is about half a mile from the main group of build- 
ings and is used to house 15 women patients who cook a "d care 
for the men employed about the farm. 

NURSES HOME, as the name indicates, is used exclusively as a 
place of abode for the women nurses and attendants when they 
are off duty. 



20 

CONVALESCENT BUILDING will be occupied in a month or two 
and will then be used for a receiving ward and the care of 
convalescent patients. 
All rooms in which patients or attendants sleep have at least one 
window. There are a fair number of windows in the halls, 
although some of them are rather dark. The attendants' rooms 
and about one- third of the patients' rooms have individual elec- 
tric lights. All buildings are lighted by electricity alone. Sec- 
tion Ten has sky-lights. 

FEMALE DINING ROOMS: There are twelve dining rooms in the 
department for women as follows: — % 

Two in Section 1, two in Section 2, one in Section 3, two in Section 
4, one in Section 10, one in Section 12, one in Stinson Cottage, 
one in Farm Cottage, one large general refectory. 

The dining rooms vary in size. Those in the regular section 
building are 23 by 21 feet. The dining room in Section 10 is 
30 by 49 feet, the one in Section 12 is 72 by 48 feet and the 
general refectory is 152 by 40 feet. 

The regular section dining rooms, such as in Section 4, accommo- 
date 28 patients. Section 10 dining room accommodates 100 
patients. Section 12 dining room accommodates 175 patients 
and the large refectory accommodates 550 patients and 60 
nurses. While these figures show the capacity of the dining 
rooms, there is not one of them that is not over-crowded at the 
present time. 

Male and female patients do not dine together. 

Male and female nurses do not dine together. 

ALL OTHER BUILDINGS: 

Surgical building, one story, brick. 

Pathological and morgue building, two story brick. 

Administration building, four story, brick. 

Chapel building, two story, brick. First floor used as quarters for 
employees; second floor used as a chapel. 

Kitchen building, three story, brick. First floor used for a kit- 
chen and dining rooms for employees; second and third floors 
used as sleeping rooms for employees. 

Refrigerator and cold storage house, two story, brick. 

Engine room, one story, brick. 

Boiler house, one story, brick. 

Laundry building, two stories, brick. 

Paint shop and damage room, two stories, stone. 

Carpenter, plumber and tinsmith shop, two stories, brick. 

Blacksmith shop, one story, brick. 

Associated dining halls, or refectories, two stories, brick, size 



21 

of halls each (two of them) 152 feet by 16 feet. (Mentioned 

above). First floor used for store rooms and work shop; second 

floor used as dining rooms. 
Steward's residence, two stories, stone dwelling. 
Porter's lodge, two stories, brick. 
Farm cottages, (three of them). Two of them are three stories, 

stone dwellings, and one is two stories, brick dwelling. 
Farm barns, (three of them). Two frame buildings, and one stone 

building. 
Stables, (three of them). One frame, one brick and one stone. 
Piggery, slaughter house and soap house (one building) built of 

concrete. 

SIZES OF HALLS AXD ROOMS: 

Ward buildings for patients, Xos. 2, 3, 1, 5, 6, and 7, consist of 
four wards each, viz: Ward A, Ward B, Ward C and Ward D, 
and each ward has a hall 136 feet long and 12 feet wide. 

Each of the above ward buildings has: 

Thirty-two rooms 7 by 10 feet. 

Four rooms 15 by 10 feet. 

Four rooms 23 by 21 feet. 

Four rooms 39 by 23 feet. 

Four alcoves 17 by 24 feet. 

From the above rooms one room each in Xos. 3, 5, 6, 7, sizes 23 
by 21 feet is used as a patients' dining room and two rooms in 
Xo. 2, while in Section 4 one room same size is used for patients' 
dining room, and one room same size for nurses' dining room. 

Ward buildings for patients, Xos. 1 and 8, consist of four wards 
each, viz: Ward A, Ward B. Ward and Ward D, and each 
ward has a hail 87 feet long and 12 feet wide; also a cross 
hall 56 feet long and 12 feet wide. 

Each of these two ward buildings has: 
41 rooms 7 by 10 feet. 
4 rooms 20 by 23 feet. 
4 rooms 10 by 16 feet. 
2 alcoves 18 by 24 feet. 
2 alcoves 18 by 38 feet. 
Two of the dining rooms 20 by 23 feet are used as dining rooms for 
patients. 

WARD BUILDING'S Xos. 11 and 12, for patients, consist of four 
dormitories and two day rooms each, also 8 attendants' rooms. 
Each has 4 rooms 72 by 48 feet. 
2 rooms 37 by 74 feet. 
8 rooms 10 by 16 feet. 



22 

In Section or Building No. 12, there is a Dining Room in the Base- 
ment, size 72 by 48, for patients. (No dining room in Building No. 
11.) 

WARD BUILDING'S FOR PATIENTS Nos. 9 and 10. known as the 
Infirmaries, each has two large dormitories, one day room and 
one dining room, as follows : 

2 rooms 70' by 38 feet. 

1 room 30 by 88 feet. 

1 room 30 by 49 feet used as Patients' Dining Room. 
Also 9 rooms 8 by 10 feet. 

2 rooms 10 by 12 feet. 

CONVALESCENT BUILDING FOR WOMEN (in course of erec- 
tion) has the following rooms : 
12 rooms 17 by 13 feet. 
32 rooms 8 feet 3 inches by 13 feet. 

4 day rooms 28 feet 7 inches by 15 feet. 

2 dining rooms 27 by 20 feet. 

HARTRANFT COTTAGE FOR MALE CONSUMPTIVES (Occupied 
by 41 patients) has the f olllowing rooms : 

3 dormitories. 
1 day room. 

1 dining room. 

1 kitchen. 

3 single rooms. 

STINSON COTTAGE for female consumptives (occupied by 22 
patients) has the following rooms: 

2 dormitories. 

2 single rooms for patients. 
1 day room. 
1 dining room. 

1 kitchen. 

5 rooms on third floor (occupied by nurses). 

FARM COTTAGE (occupied by female patients) has the following 
rooms: 

2 dormitories. 

1 day room. 

2 dining rooms. 
1 kitchen. 

3 single rooms. 

OUT DOOR EXERCISE FOR PATIENTS: 

No enclosed yard for exercise of patients, male or female. But 
the men are taken to walk by the attendants on the various 



23 

paths and roads about the grounds. The male patients remain- 
ing upon the side of the house devoted to the care of male 
patients and do not go over into the ground where the women 
patients are taken for exercise. Over 80 of the male patients 
are allowed to walk about the grounds by themselves. All male 
wards go out for exercise at least once a day and many of them 
twice a day. 

FEMALE patients are taken to walk by the attendants on the 
various paths and roads about the grounds of the Women's De- 
partment, and some of the best of them are taken for walks in 
the surrounding country. All of the female patients who are in 
good physical condition are required to be out-doors at least two 
hours each day. About eighty of the women patients have 
parole of the grounds and come and go as they please in the 
grounds of the women's department. 

FIRE PROTECTION: 

In all the Wards Fire Buckets are kept filled with water in a 
room which is easy of access to all attendants. The fire hose 
is kept in the wards. 

Each building is provided with fire hose on the inside and a water 
plug to attach hose to on the outside. There is a fire pump in 
the engine room. There is a reservoir of 5,000,000 gallons 
capacity, a cistern of 30,000 gallons capacity, and six artesian 
wells 8 inches in diameter, which supply the water for the Insti- 
tution, all of which can be put into use in case of fire. Employees 
are instructed what to do in case of fire, and Notices of Instruc- 
tion are posted all through the Buildings. 

Each Ward Building has 1.50 feet of 2 inch hose for the attic. 

Each Ward Building has 150 feet of 2 inch hose for the wards. 

Nurses' home has 750 feet of fire hose. 

Stinson Cottage has 300 feet of fire hose. 

Administration Building has 150 feet of fire hose. 

Fire extinguishers are distributed through all the buildings at 
convenient places, and they have a hose truck containing 500 
feet of fire hose. 

Farm barns have 300 feet fire hose. 

Kitchen building has 150 feet fire hose. 

Chapel building has 100 feet fire hose. 

Piggery has 300 feet of fire hose. 

Convalescent building for women has 600 feet of fire hose. 

Weekly inspection is made of the condition, etc., of the fire hose, 
and frequent tests are made of the pressure, etc., of the fire 
plugs. 



24 

VENTILATION: Ventilation is accomplished by a system of hot air 
flues and natural draft with ventilators at the top and bottom 
* of each room. The hot air ventilators in the basement are in 
close relation to supply ducts which connect with the outside air. 
The wards are thoroughly ventilated by raising the windows 
at stated times during the day and by keeping a number of 
windows open during the night. 

CAPACITY: The normal capacity for the Department for Men is 
approximately 800. , 

The normal capacity for the Department of Women is approx- 
imately 985. 

POPULATION: The population of the Department for Men on Feb- 
ruary 18th, 1907, was 1,197 patients, of these 13 were private 
patients. 
The population for the Department for Women on February 18th, 
1907, was 1,278 patients; of these 27 were private patients. 

PER CAPITA COST: The per capita cost of maintenance for the 
Hospital, year ending September 30th, 1906, was $3.70. 

PERCENTAGE OF DEATHS: Males— .The percentage of deaths 
based on the whole number under treatment for last year was 
7.3. 

Females — The percentage of deaths based on the whole number 
under treatment for last year was 5.7. 

DISCHARGES: Males — The number of discharges for the last year 
ending September 30th, 1906, was 68; of these there were dis- 
discharged as 

Restored, 32. 

Improved, 19. 

Unimproved, 17. 

Females — The number of discharges for the year ending Septem- 
ber 30th, 1906, was 80; of these there were discharged as 

Restored, 33. 

Improved, 25. 

Unimproved, 21. 

Not insane, 1. 

Number of male patients taking medicine at present time is 118. 

Number of male patients confined to bed at present time is 47. 

Number of Female patients taking medicine at present time is 
186. 

Number of female patients confined to bed at present time is 33. 

SALARIES: The salary of the Chief Physician in the Department 
for Men is $2,500. The number of Assistant Physicians in the 



25 

Department for Men is three. The salary of the First Assistant' 
is $1,200, the other two Assistants are paid $900 each. 
The salary of the Chief Physician in the Department for Women 
is $2,500. The number of Assistant Physicians in the Depart- 
ment for Women is four. The salary of the First Assistant is 
$1,200; the next Assistant receives $900, and the other two 
Assistants receive $50 per month. 

NUESES: Males — The number of graduate male nurses is 26. Their 
salaries range from $25 to $40. Hours employed are from 6 
A. M. to 8 P. M., but on alternate nights they are relieved from 
duty at 6 P. M. They are allowed one half day a week off duty 
and every third Sunday. 

The nurses in charge of each ward where there is a Ward Dining 
Eoom are allowed one hour off duty during the day in addition 
to this time. 

Female — There are 108 nurses in the Women's Department who 
have either graduated from the Training School or are now 
taking training. Their salaries while in the Training School 
range from $16 to $19 per month. After graduation, they range 
from $20 to $35 per month. 

Hours employed are from 6 A. M. to 8 P. M., but on alternate 
nights they are relieved from duty at 6 P. M. The days they 
are on duty until 8 P. M., they are given an hour to themselves 
at some time during the day. Curses are allowed one-half day 
a week off duty and every third Sunday. 

ATTENDANTS: Male— There are 100 undergraduate nurses and 
attendants in the Male Department. 

Their salaries range from $18 to $25. 

The nurses for the most part sleep in rooms along the ward halls. 
A few of the attendants sleep in rooms in the third story of 
one building. Those attendants whose patients eat in the large 
refectory eat also in this dining room at one end, this portion 
of the dining room being screened off from the part occupied by 
patients. Those employees whose patients eat in ward dining 
rooms eat in the same dining room as the patients, at separate 
tables. 

Female — There are 30 attendants in the Women's Department. 
Their salaries range from $16 to $25 per month. The hours on 
duty are practically the same as those stated for graduate 
nurses. 

With the exception of about 20 nurses who sleep in rooms along 
the ward halls as a measure insuring safety in case of an 
emergency at night, all of the nurses and attendants in the 
Women's Department sleep in the nurses' home. 



26 

Those nurses whose patients eat in the large refectory eat there 
also. Their tables are at one end of the room and somewhat 
apart from the patients' tables. Those nurses whose patients 
eat in the ward dining rooms eat in the same dining room as the 
patients at separate tables. 

The Supervisor and Head Nurses have a dining room of their own 
'separate from the patients' dining rooms. 

EMPLOYMENT: Males — At present there are 542 male patients em- 
ployed as follows: 

Ward dining rooms, 29. 

Large refectory, 40. 

Sewing and mending, IS. 

General ward work, 264. 

Laboring in stables, 2. 

Laboring on farm, 4. 

Laboring in chickery, 4. 

Laboring an garden, 11. 

Laboring on Grounds, 46. 

Conservatory, 2. 

Mattress shop, 3. 

Printing office, 9. 

Shoe shop, 7. 

Tailor shop, 9. 

Carpenter shop, 1. 

Paint shop, 2. 

Brush shop, 34. 

Basement, 6. 

Playing in brass band, 14. 

Laundry, 11. 

Kitchen, 8. 

Other work, 18. 

In the summer season the force of working men is considerably 
augmented as probably, at least, one hundred additional men 
work during this season in various kinds of labor about the 
grounds. 

The percentage of male patients employed at the present time is 
approximately 45 per cent. 

Females — At present there are 660 women patients employed as 
follows: 

Laundry, 93. 

Centre kitchen, 14. 

Kefectory, 52. 

Basket shop, 12. , 

Sewing rooms, 52. 



27 

Housework, 303. 

Dining rooms, 71. 

Sewing and Mending, 49. 

Other work, 14. 

At present the brush shop in the Women's Department is not in 

operation. When the patients are working there, 25 more are 

employed. 
The percentage of patients employed at the present time is 52 per 

cent. 

MANUFACTURING: Males— The ocly manufacturing done in the 

Male Department is that of brushes. For the year ending 

September 30th, 1906, 21,330 brushes were made, 1,404,768 holes, 

of a total value of f 110.43. 

Females — Clothing, baskets and brushes are manufactured in the 

Women's Department. 
Clothing manufactured during the last year is as follows: 
Dresses and wrappers, 3,700. 
Skirts, 2,545. 
Drawers, 3,800. 
Chemises, 1,500. 
Nightgowns, 2,400. 
Aprons, 5,200. 
Sun bonnets, 300. 

In addition to these articles much of the making of sheets and 
pillow cases, hemming of towels, napkins and table cloths, etc., 
has been done by the patients of the Women's Department. 
In the basket shop 305 baskets of various shapes and sizes were 
made and sold for f 170.80 during the past year, as follows : 

Baskets delivered to storekeeper, 60 f 40.70 

Baskets sold, 245 130.10 

Total number made, 305 $170.80 

Owing to the lack of help and inability to get an attendant to look 
after the brush shop, it has not been running for the past year. 

WATER- SUPPLY: The water supply is obtained from artesian 
wells, 

HEATING SYSTEM: Steam system of heat, mostly by the indirect 
method. 

SEWAGE: The Wearing system is used. The effectiveness of this 
system depends upon the destruction of the disease bearing 
germs by the action of the nitrifying bacteria found in the upper 
lavers of the soil. 



28 

This system has an area of twelve acres. The sewage is 
conducted to all parts of this ground by a system of ditches 
made from half-round pipe, which overflow, covering the entire 
surface, percolating through the ground into a system of under- 
drain tile. This tile is from three to eight feet under the sur- 
face. The water from this underdrain goes into the Stony 
Creek. This plot of ground has not been used for the past two 
years. 

The sewage at the present time is disposed of as follows: 

All the sewage from the different buildings is collected in a reser- 
voir which holds 75,000 gallons. From this reservoir it is de- 
livered by gravity to the highest points to which it will flow, to 
a small cistern, and from this cistern it is distributed in half- 
pipe (18 inches in diameter) ditches over the surface of the fields. 
The area covered by this latter system is about forty acres. 

The Institution has two employees who put gates in these ditches 
at different points, and flood a certain portion at a time, until it 
will absorb no more water, then flood it in a new portion. Under 
this arrangement there is no water that flows into the Stony 
Creek, the ground absorbs all and the sun and air has a chance 
to reach all of the surface irrigated in this way. 

TREATMENT: Males — Patients are treated along the usual lines, 
medicine being employed wherever it is of any possible value. 
Exercise in the open air is given as far as it is deemed judicious. 
Employment is provided as far as the facilities of the Hospital 
will permit, and where it is deemed best for the patients' wel- 
fare and strength. 

AMUSEMENT: Amusement, such as dancing, stereoptican enter- 
tainments, and every other form of entertainment obtainable, 
games of all sorts, music, baseball and croquet; in short, every- 
thing devisable in the way of amusement and the finances of the 
Hospital will permit. 

The . treatment of disturbed and restless patients by means of 
cold and hot packs has been introduced within the last two 
months. Warm baths for sedative effects are also used in cases 
where they are indicated. The nurses in the Training School are 
taught methods of giving these packs for treatment of acute 
cases. 

Dietetic treatment is established in the case of the epileptics. 

About two months ago a special diet table was arranged for all of 
the epileptics in the house, the diet being suited to their partic- 
ular needs. 



29 

Females — So far as the equipment will permit, the patients are 
treated along the lines indicated by modern methods of care of 
the insane, and follows on lines governing the male patients. 

There is no regular hydro-therapeutic plant in the hospital, but 
hot and cold packs and prolonged warm baths are used in the 
treatment of restless and disturbed cases and all others in 
which they are indicated. Massage also is used. The nurses in 
the Training School are taught both massage and the giving of 
packs. In addition to these methods of treatment wherever the 
condition of any patient demands the intervention of surgery, on 
account of pelvic or other disorders, the operation is performed. 
The patients' eyes, ears, noses, throats and teeth also receive 
attention. 

CONVALESCENT AND RECEIVING BUILDING: Males— At the 
present time the Institution has not a Convalescent and Receiv- 
ing Building, but the Board of Trustees have asked the Legis- 
lature to appropriate f 60,000 for the purpose of building such a 
building. During the last three months a separate ward for 
receiving patients has been established and is being fitted up as 
well as circumstances will permit for temporary use in this 
capacity, until new buildings can be erected. The new Convales- 
cent and Receiving Building is expected to accommodate eighty 
patients. 
Females — At the present time a convalescent and receiving build- 
ing is being erected for the Women's Department. 
The State Hospital for the Insane of the South-eastern District 
of Pennsylvania at Norristown was established by Act of Assembly 
approved May 5th, 1876, P. L. 121, and opened for patients July 12th, 
1880. 

Seven counties comprise the district from which it was to receive 
patients. 

The Institution is divided into two departments, one for the male 
and one for the female. 

Dr. W. W. Richardson is the Superintendent of the Male Depart 
ment and has been connected with the Institution since the 15th 
of November, 1906. Prior to that he was connected with the Phila- 
delphia Hospital, Ohio State Hospital for Insane at Columbia, and 
the Government Hospital for the Insane at Washington. He 
graduated from the University of Pennsylvania in 1902. 

Dr. Mary M. Wolfe is the Superintendent of the Female Depart- 
ment. She has been connected with the Institution since the 14th 
of August, 1899, and has occupied her present position since the 1st 
of February, 1901. She is a graduate of Bucknell University and the 



30 

University of Michigan Medical Department since 1899, and has been, 
at Norristown continuously practically since her graduation. 
John I. West is the Steward. 

It is under the control and management of a Board of thirteen 
Trustees, five of whom are appointed by the Governor, two by the 
City Councils of Philadelphia, and one by the County Commissioners 
of each of the Counties embraced in the District. 

February 18th, 1907, we find practically housed under one roof 
2,475 patients in this institution, which is almost three times the 
number that should be cared for under one executive management 
as has been shown by the testimony of the eminent alienists 
who testified before your Commission as witnesses upon this 
subject. Here it is true, the males and females are governed by a 
separate and distinct management, and while this may have re 
suited in fairly efficient returns from time to time in the past, in 
view of the advancement hoped to be made in the future, it cannot 
be recommended. To say that there is a Superintendent for the 
males and females and that each is independent of the other, means 
a division of authority in the household which cannot be productive 
of good. It is a system we have found in no other like institution. 
Notwithstanding this enormous population which we believe to be 
beyond the proper control of good management and efficient care 
which should be exercised by those in charge, we find those in author- 
ity still willing to place additions to the buildings already con- 
structed in order that its population might be increased. 

If no restraint is placed upon the growth and expansion of this 
institution there is no reason in the world why in a very few years 
they should not have under treatment in Norristown several thous- 
and more patients. 

The concensus of opinion is that no Institution should exceed 
over twelve hundred inmates and that even one thousand is sufficient 
for one executive to properly manage. 

Authority in all walks of life and in all business undertakings 
should be lodged somewhere. Here it should be lodged in one 
Superintendent and not in two, and in the Board of Trustees. The 
Superintendent should be acquainted with each and every one of 
his patients, therefore the number must be limited. 

In this Institution where new buildings have been constructed and 
base corridors have been made they have not been constructed in 
accordance with modern ideas. For instance, those leading from the 
Administration Building to the Ward Department are uncovered. 
They are useless other than for sidewalk purposes. They are not 
covered on top nor on the sides. They cannot answer any better 
purpose that we know of other than that which we have designated. 
In stormy or inclement weather it is not feasible foy patients to pass 



31 

to and from one building to another, and what good purpose they 
can serve is beyond the comprehension of your Commission. The 
long dark corridors are here in evidence. The patients sit in them 
on benches idly and purposelessly from day to day and more in 
accordance with the past century usage than that of the up-to-date 
20th century provisions. 

Of course a great deal of this is due to the fact of the over-crowded 
condition of this institution and the inability thereby to classify 
properly the patients. 

Furthermore in these corridors we find sentinels on duty housed 
in small structures to keep constant watch upon all movements of 
the patients. It is not found in any other Institution and is a relic 
of ancient times in the management of Hospitals which should be 
abolished. 

Treatment of this character has a tendency to keep patients in a 
constant state of fear and should not be tolerated. 

The custom of the patients dining in one large hall is disapproved. 
Much better results could be obtained if they were to a greater 
degree classified and cared for in that way. 

The ventilation is bad and the daylight is insignificant to what 
it should be. The buildings are lighted with electricity, and, with 
the exception of the attendants' rooms and about one-third of the 
patients' rooms, which have individual lights, the others have none. 
This system of lighting is condemned, as upon examination it can 
be ascertained the more modern institutions furnish electric lights 
in all rooms which are placed in the ceilings protected 1 y a wire 
netting or over the doors. 

This Institution complies with the provisions of the Act of As- 
sembly, July 5, 1883, P. L. 177, which requires advertisements to be 
inserted for bids for furnishing supplies. 

The system of sewage adopted at this institution has not given 
entire satisfaction by reason of the character of the soil, and the 
problem for its perfection will have to be worked out in the future. 



32 



STATE HOSPITAL FOR THE INSANE, 
DANVILLE. 



GROUNDS: 

Acreage, 394 acres. * 

Under cultivation, 216 acres. 

Garden, 35 acres. 

Not under cultivation, 143 acres. 

BUILDINGS: 

The main building consists of three sections, each section three 
stories high, with two wards for each sex in the fourth story. 

SIZES OF HALL: 

210 to 220 feet, 12 feet in width, all ceilings 12 feet high. All 
halls of third story with the exception of two wings upon the 
male side, contain a bay window, used as a sitting room. The 
single individual room for patients is 8 by 10 by 12 feet. There 
are a few dormitories varying in size, accommodating three, 
five and ten beds. These were originally intended for day 
rooms for patients. One infirmary for sick and helpless males, 
one story high, with a capacity of 100. 

22 other buildings, four of which are used as dwelling houses 
for employes, the balance consisting of engine and dynamo build- 
ing, laundry, stable, chicken house, &c. 

The building is constructed of rough stone and plastered ex- 
teriorly. 

The partitions are of brick. 

The lavatories in these wards connected by a 12 foot corridor are 
built of brick. 

LIGHTING: 

All the buildings are lighted by electricity, except the sleeping 
rooms for patients. 

DINING ROOMS: 

There are twenty-three ward dining rooms for patients. That of 
the annex connected with its own kitchen, has a. capacity for 
150 patients. Twelve are 18 by 30, accommodating 45 patients 
each. 



33 

Six are 16 by 24, accommodating 43 patients each. 
Two are 16 by 27, accommodating 43 patients. 
Two are 18 by 33, accommodating 45 patients. 
These are located directly in the ward. 

'Male and female patients do not dine together, but dine in the 
same dining rooms. 

ENCLOSED YARD: 

There are three yards for each sex for recreation, six in all. The 
combined area is about six acres. Most of these yards are 
walled-in and covered with a roof around the edge. 

FIRE PROTECTION: 

Protection in case of fire is provided by a six inch water main, 
with plug and two outlets in front and rear of each section and 
at each end of the main building, about 100 feet from the build- 
ing, by use of a pump producing a pressure of 120 to 125 pounds. 
Fire hose is on a reel located in the cellar, in the front and 
rear of each division. There are two other places where three 
additional reels of hose can be found upon a carriage. There 
is 5,000 feet of H inch and 1,600 feet of 2J inch hose. In the 
wards is a stand pipe connected with this same fire line and 
1-J inch hose on a reel of sufficient length to cover the length of 
the building. In addition, a chemical fire engine, 60 gallons is 
provided for 300 feet of 1 inch hose, located in the basement of 
the Administration Building; also a chemical engine of 50 gal- 
lons on the top floor accessible to the Amusement Hall and all 
wards of this level. An organized fire company of twelve regu- 
lar members is drilled in the use of the apparatus in charge. 
Fire proof stairways are constructed at each end of every divis- 
ion. The lavatory buildings of four sections are fire proof 
separated from the main ward by a steel rolling door and each 
of these buildings has a fire escape. Twenty fire extinguishers 
of different sizes and makes are distributed in various parts of 
the building and outbuildings. 

VENTILATION: 

The system of ventilation is forcible, a 12 foot fan collecting air 
from a tower about 35 feet in height, forcing the air through 
underground ducts to two divisions in the male side and two 
in the female, entering the middle division or pipe cellar. This 
air finds egress through the heat flues furnished each room 
and by separate ducts to a given duct beneath the roof of the 
building, terminating in open ventilators upon the roof. This 
3 



34 

method is used to ventilate the halls and bed rooms of the maia 
wards. The lavatory building has ah air shaft reaching from 
the cellar to the ventilator on the roof. This duct also carries 
water and soil pipes, etc. In the central portion of the main 
building and the annex the air is brought in entirely by under- 
ground ducts, ventilating shafts running from the room directly 
to the ventilators upon the roof. In the halls the ventilators 
open near the ceiling; in the bed rooms, near the floor. 

CAPACITY: 

Men, 500 

Women, 450 

Total, 950 

POPULATION: 

February 15, 1907, 680 men. 

February 15, 1907, 609 women. 

Total, • 1289 

Private patients, 22 men and 25 women. 

PER CAPITA COST OF MAINTENANCE: 
$3.73 per week. 

DEATHS: 

1906 there were 91 deaths. 

PERCENTAGE OF DEATHS TO POPULATION, 6.14. . 

DISCHARGES: 

Improved, 49. 

Cured and restored. 47. 

SICK PATIENTS: 

Male, 7. 

Female, 12 on February 17th, 1907. 

NUMBER OF PATIENTS CONFINED TO BED FEBRUARY 17th, 
1907: 

Male, 81. 
Female, 25. 



35 



SALARIES: 



Superintendent's salary, $4,000. 
1st Assistant Physician, $1,500. 
2nd Assistant Physician, $1,300. 
3rd Assistant Physician, $1,100. 
4th Assistant Physician, $800. 
Woman Physician, $1,000. 

NURSES: 
MALE 

Number, 28. 

Salary, $33 to $37 monthly. 

FEMALE 

Number, 31. 

Salary, $24 to $27 monthly. 
Hours employed, male and female nurses, 5.30 A. M. to 9 P. M. 

UNDERGRADUATE NURSES MALE 

Number, 29. 

Salary, $20 to $30 monthly. 

Employment, 5.30 to 9 P. M. 

UNDERGRADUATE NURSES FEMALE 

Number, 27. 

Salary, $16 to $21 monthly. 

Employment, 5.30 A. M. to 9 P. M. Two hours leave of absence 
between 9 A. M. and 7 P. M. 

MALE ATTENDANTS salaries are $20 per month for the first three 
months, to $35. 

FEMALE ATTENDANTS salaries are $16 per month for the first 
three months, to $25. Board and washing and a half day's 
leaye of absence eyery week and one week's leave every six 
months. 

The nurses have a separate dining room in the centre building, 
taking their meals one hour before the patients meals. The 
sexes dine separately. These meals are served at different 
times, one half remaining in the wards while the other half 
have their meals. The male nurses sleep in the wards occupied 
by patients with the exception of 15, who live outside of the 
building in their own homes. 

The female nurses sleep in the Nurses' Home, a separate building 
erected for the purpose, with the exception of 12, the head nurses 
of each ward, who have their rooms in their respective wards. 



36 



PATIENTS EMPLOYED: 



Number of patients employed for the month -of January, 1907, was 
229 men and 231 women, total, 503, or 41 per cent, of population. 
The men were engaged in the scullery, in the kitchen, the mat- 
tress room, quarrying, breaking stone, road building, ditching 
for sewer and other pipe, etc. 

ARTICLES MANUFACTURED: 

Articles such as clothiag for the female patients, linen for bedding, 
and towels are made by the inmates, and undershirts for men 
and mattresses. 

WATER SUPPLY: 

The water supply is direct from the Susquehanna River. It flows 
by gravity to a well, whence it is pumped to a filter, thence to 
a reservoir 75 feet higher than the base of the building, and 
supplies the institution by gravity. 

HEATING: 

The heating is indirect, each room having a separate flue. 

SEWAGE: 

The sewage is disposed of by irrigation, collected in a 20,000 gal- 
lon reservoir, thence to a 10,000 gallon reservoir on the highest 
point on the farm, where it is distributed by gravity to various 
sections. The nurses home sewage is" not included in this as 
yet. If repairs are needed to the pump, the sewage passes into 
the river. 

CONVALESCENT AND RECEPTION WARDS: 

There is a ward for the reception of all acute cases where they 
receive the rest treatment and the usual medical care required 
and the hot water treatment. When improved, the case is 
transferred to the convalescent ward. No reception ward can 
be provided, owing to the crowded condition. 

TREATMENT: 

The segregation of the acute from the chronic cases, due atten- 
tion to rest in acute cases, the procuring of sleep, and nourish- 
ment, with exercise out of doors, has been the method of treat- 
ment of acute cases. 

For chronic cases, as much life in the open air as possible, with 
occupation on the farm. 



37 

The Superintendent of this institution is Dr. Hugh B. Meredith, 
and he has been at its head since 1891. He graduated from the Uni- 
versity of Pennsylvania in 1877 and has been connected with the 
institution for twenty-eight years. 

This institution was founded under an Act of Assembly approved 
April 13th, 1868. 

Twenty-one Counties comprise the District from which it receives 
its patients. 

The first patient was admitted to the institution November 6th, 
1872. 

The control of the institution is vested in a Board of nine Trustees 
appointed by the Governor. 

As an instance of the antiquated institutions of the State of Penn- 
sylvania this Commission would specify Danville. It has all the 
unfortunate inferior features connected with almost every depart- 
ment, and but few of the good. 

While among the old institutions of the State it seems it has dis- 
regarded the trend of modern improvement and today stands last in 
the list of Pennsylvania institutions in this respect. 

The patients do not receive the proper classification because of the 
methods of construction used in the buildings. 

We recommend that no money shall be appropriated for the im- 
provement of these old buildings except as hereinafter mentioned. 

We consider the ventilation bad and the daylight and the sun- 
light are entirely insufficient and cannot be too severely condemned. 

We found in this institution many men wearing nothing but 
underclothing. Realizing that it has been testified before us that 
in certain very violent cases, patients are better subdued and con- 
trolled by the fact that they are kept in underclothing only, for the 
reason of giving the appearance that they are sick to the extent 
that they cannot wear clothes, at the same time, we recommend that 
the management shall give special care and attention in teaching 
them to wear clothing. 

Less modern improvements have been made to this institution 
than any other in the State and it has not advanced or kept progress 
in modern construction, in management and treatment as the State 
has a right to demand. 

The old buildings are greater contracted than others of a like 
character. The corridors, as has already been stated, average from 
210 to 220 feet long, with a ten foot ceiling and are lighted from 
both ends with few exceptions, where an offset has been constructed 
about midway of the same. On both sides of the corridors are 
constructed rooms where most of the patients are confined, the ex- 
ceptions being those who sleep in the few small rooms called dor- 
mitories, which, however, were not constructed for that purpose. 



38 

Notwithstanding that provision was made by an appropriation for 
iron bedsteads in this institution, which to every mind must appear 
more cleanly and healthy than wooden ones, they have not all been 
purchased and placed in position for use, the Superintendent stating 
that he preferred wooden ones. The odor from the wooden bed- 
stead in an institution of this kind, which almost constantly is 
required to be soaked with carbolic acid or some other disinfectant 
becomes obnoxious and should not be tolerated. 

We cannot recommend that any money should be appropriated 
for the improvement of these old buildings. We recommend that 
they should be razed to the ground, with the exception of that part 
used for administration purposes which we consider to be in good 
condition. 

The Nurses' Home is built on modern plans and we have no com- 
ment to make other than favorable. 

The Infirmary is also a modern one and the same consideration 
can be extended to it. 

As to the statements in regard to the death of two patients 
through the alleged violence of attendants, we cannot sustain them. 
The Superintendent testified that in one instance two attendants, 
who used such force on an unwilling patient, whom they were en- 
deavoring to compel to take a bath, which caused his death, should 
have been tried for homicide, instead of being discharged by a 
Coroner's jury. This, however, was denied by counsel for the Board 
of Trustees, who furnished the Commission with a copy of the ver- 
dict of the Coroner's jury, which discharged the attendants. 

We recommend that the long dark unventilated halls should im- 
mediately be temporarily remedied by the installation of ventilators 
and windows so that more light, air and sunshine may be let in until 
a new and complete institution can be erected. 

The same trouble is here experienced with the employment of 
nurses as in the other institutions, and we may expect this difficulty 
to continue as long as the nurses are paid such meagre wages and 
required to serve such long hours and are compelled to live during 
the day in the wards and to sleep and eat in the same. 

Although the Act of June 22, 1883, P. L. 149, provides that the 
Superintendent for two successive weeks and yearly thereafter the 
same length of time, commencing oh the first Monday in April shall 
advertise in three newspapers of general circulation for bids to 
furnish all needed supplies for the year beginning June 1st next 
ensuing, and to furnish on application itemized lists of the kind of 
supplies required and to award the contract for the same to the 
lowest and best bidder, taking security for the faithful performance 
of the contract, the same has not been complied with at this institu- 
tion. We recommend that the management should comply with the 
provisions of this. 



3y 

The sewage system is disposed of by irrigation, and when the 
pump is out of order, it passes into the Susquehanna river. We do 
not consider this system perfect by any means and sooner or later 
it will have to be improved. 

The patients' rooms in this institution are not lighted, although 
electricity is supplied from the institution's plant to the buildings. 

Electric lights should be installed in every room and we earnestly 
recommend that this shall be clone at once. 



40 



THE WESTERN PENNSYLVANIA HOSPITAL 
FOR THE INSANE, DIXMONT. 



ACREAGE: 

373J acres. 

About 200 acres under cultivation. 

About 173 J acres used for pasturage, etc. 

BUILDINGS: 

1 main Building. 

1 Brick Annex Building. 

2 Frame Cottages. 

Main building is three and four stories high. 

Annex two stories high. 

Cottages, one story each. 

The halls in the Main Building are 12 feet wide; rooms S by 10 

feet. They are used for patients. 
The buildings are constructed of brick and stone; tile floors. 

LIGHTING: 

The buildings are lighted by electric light. 

DINING ROOMS: 

There are 22 dining rooms in main building, one in each other 
building. In the main building they are 24 by 25 feet, and are 
located at the end of the corridors, and seat 40 patients each. 

ENCLOSED YARD: 

The male and female patients and nurses do not dine together. 
There is no enclosed yard about the institution. 

FIRE PROTECTION: 

System adopted for the protection of inmates consists of fire hose, 
buckets and extinguishers, stand pipes, fire doors, inspections by 
the Board of Fire Underwriters, etc., and large fire escapes. 



41 
VENTILATION: 

There is no regular system of ventilation. 

CAPACITY: 

The normal capacity is 600. 
The present population is 962. 
Private patients number about 100. 

PER CAPITA COST MAINTENANCE: 

The per capita cost of maintenance is $4.36. 

PERCENTAGE OF DEATHS 1906: 

The percentage of deaths for 1906 based on total number under 
treatment was 7.82 per cent. 

NUMBER OF DISCHARGES 1906: 

Improved, 65. 
Unimproved, 7. 
Restored, 33. 
Died, 90. 

Six or seven patients are sick at the present time. 
All acute cases, also maniacal cases and others for various reasons 
(medical), are confined to their beds. 

SALARIES: 

The Superintendent's salary is $3,500 per annum. 
- Four physicians are on the hospital staff in all.- 
First Male Assistant, salary, $2,000. 
Woman Assistant, salary, $1,500. 
Third Assistant (male), $1,000. 

NURSES: 

Male. 70. 

Salary from $22 to $35. 

Employed from 6.30 A. M. to 7 P. M. 

Female, 43 to 45. 

Salary from $20 to $25. 

Employed from 6.30 A. M. to 7 P. M. 

Also night watch outside, inside and attendants on duty. 

All attendants in this institution are counted as nurses. 



42 

Male nurses sleep in nurses 1 rooms and eat in patients' dining 

rooms. 
Female nurses sleep in nurses' rooms and in the female nurses' 

home. 
All nurses, male and female, eat with their respective patients in 

patients' dining rooms. 
There is the same bill of fare for nurses and patients. 

EMPLOYMENT OF PATIENTS: 

Some patients when able are employed on the farm, garden, dairy, 

lawns, drive-ways, caring for shrubbery, etc., etc. 
During the summer, fall and spring months, about 50 per cent. 

all who are able and all who are directed to be employed by the 

doctor are employed. 
Nothing is manufactured, the Superintendent claiming there is 

plenty of congenial occupation without that. 

WATER SUPPLY: 

The water supply is obtained from large springs for drinking and 
cooking purposes. For other purposes it is obtained from the 
Ohio river. 

HEATING: 

The buildings are heated by steam. The main building by indirect, 
and all other buildings by the direct system of heating. 

SEWAGE: 

The sewage from the institution is emptied into the Ohio river. 
River water is used in the buildings, filtered for house cleaning 
purposes only. Spring water is used for drinking and cooking. 

The institution has a convalescent and receiving ward, both in 
main building. 

Dr. Henry A. Hutchison, M. D., is the Superintendent and has 
been for twenty-six years connected with the institution. He 
graduated from the University of Pennsylvania. 

This Institution was erected under the provisions of an Act of 
the Legislature approved March 14, 1848, P. L. 218. Thirteen Coun- 
ties comprise the district from which inmates are to be received. 

It was open for the reception of patients in March, 1853. 

The management claims that this is not strictly a State institu- 
tion. It was built and maintained jointly by private contributions 
and State appropriations. 



43 

The control of the Hospital is vested in a Beard of twenty-one 
managers elected by the contributors, twenty-eight life members, 
made ouch by contributing f 1,000 each, and three Managers appoint- 
ed by the Governor. The General Board of Managers appoint an 
Executive Committee who supervises the work of the institution. 

Here we find the old monasterial method of construction. Long 
dark halls with small rooms on either side. 

In its entirety as we have stated it was constructed on ancient 
methods and therefore under no circumstances in our opinion can 
modern classification, treatment and care be extended to its patients. 
The Superintendent frankly informed the Commission that it was 
not the desire of the institution to obtain aid from the State and 
at the present session of the Legislature no application was made 
for the same. Your Commission was of the opinion, however, that 
it was its duty to investigate this institution because eight hundred 
and sixty- two patients, wards of the State, are housed and treated 
there and which the State maintains. 

We find very few of the modern methods of treatment adopted. 

The Doctor in attendance was, as we have found in all institutions, 
gentlemanly in deportment and affable in manners, but he was un- 
able to convince this Commission that he had a fairly modern up-to- 
date institution. 

Repeatedly we asked him questions that would have enabled him 
to show us what his desires were and as frequently as we repeated 
the questions did he answer that he had none and positively testi- 
fied that he did not hereafter intend to ask any aid from the State 
for the improvement of his institution, and was perfectly willing for 
the patients maintained there at the State's expense to be removed 
in order that the institution might resume its original character and 
be known as an entirely private one. 

We, therefore, recommend, that in view of this fact and alsio 
because there is no other institution in the Western part of the 
State, the building of a modern insane Hospital to be located in 
one of the Western Counties. 

While, therefore, it is intended that this institution shall resume 
its 'original business of treating private patients only, we do not 
feel that we would be justified in making any unduly severe critic- 
ism regarding its management, but in as much as such a large num- 
ber of inmates must there be maintained by the 'State until they are 
removed to another institution which will cover a period of consider- 
able time, we think that we have a right to make some suggestions 
which in a measure will benefit such inmates in their treatment and 
care while they may remain. 

During the day the light was inferior in every respect to what 
it should have been and the ventilation was bad. A large amuse- 



44 

ment hall accommodating between four and five hundred inmates was 
closely examined and your Commission was unable to discover a 
single ventilator. In passing through some of what were considered 
their best corridors the bad odor was most pronounced, due to 
improper ventilation. 

The patients here are confined in separate rooms at night and 
many of them most of the time during the day. Patients by the 
dozen were sleeping and lounging on the benches in the long dark 
corridors which under no circumstances should be permitted. 

While electric lights were found in the corridors the most advanced 
and improved patients were denied this privilege at night in their 
rooms. 

A young woman inmate escaped from the institution without ever 
being accounted for. How she got out, where she is now, or what 
were the conditions surrounding her disappearance no person sum- 
moned before us could teU. Your Commission is of the opinion 
that the Superintendent was in no wise responsible for the escape 
of this inmate, but that it was the result of the collusion and con- 
nivance of one or more attendants having charge of the ward in 
which the inmate was confined. The testimony seemed to show 
that the patient's clothes were placed in a bath room at the end of 
the ward where she was confined and at night after the ward was 
supposed to be closed she escaped* by means of a door leading from 
there into the outside. The key to this door was in the custody of 
one of the attendants. The testimony further showed that for a con- 
siderable length of time there had been manifest a very great friend- 
ship between this particular patient and her two attendants. Shortly 
after the escape of the inmate the attendant who was under suspi- 
cion left the institution. 

According to the testimony the Superintendent had no trouble 
to employ and retain nurses notwithstanding their hours and wages 
were about the same as those found in all others. 

Here we find the sewage emptying into a public stream, the Ohio 
River. Sooner or later this system must be changed. 

Although the Act of June 22nd, 1883, P. L., 152. provides that the 
Superintendent shall, as soon as practicable after the passage of 
this act, for two successive weeks, and yearly thereafter, for the 
same length of time commencing on the first Monday in April, ad- 
vertise in three newspapers of general circulation for bids to furnish 
all needed supplies for the year beginning June 1st next ensuing, 
and said Superintendent shall furnish promptly on application to 
all persons desiring to bid an itemized list of the kind and probable 
amount of supplies required, and the Managers shall award the con 
tract for such supplies to the lowest and best bidder, taking such se- 



45 

curity for the faithful performance of the contract as they may deem 
necessary, the provisions of the same have not been complied with, 
but on the contrary blank schedules are sent to various merchants or 
manufacturers who produce the various commodities required and 
the contract awarded onbids received in this way. This we cannot 
commend, as .we believe the Act should be strictly complied with. 



40 



STATE ASYIyUM FOR THE CHRONIC INSANE 
OF PENNSYLVANIA. 



WERNERSVILLE. 



GROUND: 

Acreage, 860 acres. 
Under cultivation, 375 acres. 
Not under cultivation, 485 acres. 

A good part of the ground was purchased to protect me water 
supply. 

BUILDINGS: 

Number, 12, as follows: Administration Building, 4 Ward Build- 
ings, Attendant's Dormitory, Dining Room and Assembly Hall 
(1 building), Kitchen Laundry, Men's Day Room, W'ork Shop, 
Farm House used as a temporary infirmary. 

In addition four cottages occupied by employes' families. Four 
barns and stables, grist mill, wheelright shop, blacksmith shop, 
pump house, ice plant, slaughter house, etc. 

NUMBER OF STORIES: 

Ward Buildings have two stories, Administration Building 3 
stories; of the balance none have more than two. 

SIZE OF HALLS AND ROOMS: 

Ward Buildings contain four dormitories, two on each floor and 
connected with each other by two side stairways of slate and 
metal composition. One dormitory is 29 feet wide by 65 feet 
long, with an offset 13 feet wide by 28 feet long, and the other is 
29 feet wide by 55 feet long, connected by a hallway 59 feet 
long and 6 feet 4 inches wide. Eight separate rooms are along 
this hall, six being used for patients and two for attendants. 



47 

BUILDING MATERIALS: 

The building material used in construction is brick, stone and 
steel of wards, kitchen, laundry, dining room, assembly hall, 
work building, and day building. 

LIGHTING : 

The building in which the patients are housed and the rooms are 
lighted by electricity. 

DINING ROOMS: 

Five. One 67 feet wide by 125 feet long including an offset at one 
end 50 feet wide by 30 feet long. Part of this space is used for 
attendants and the remainder being separated by a partition 
used as a pantry. In this room sbout 730 patients of both 
sexes take their meals, as do also the women and men attendants 
at one and the same time. • 

Infirmary dining room, 13 feet wide by 17 feet long, used by 25 
male patients, 

Dining room for male employes in kitchen building 15 feet wide 
by 21 feet long, accommodates 25 people. 

Small dining room second floor men's ward building, 10 feet by 
19 feet, used for 16 male patients. 

Small dining room under the women's ward buildings, 9^ feet wide 
by 10 feet long, used for six women patients. 

ENCLOSED YARD: 

No enclosed yard for the exercise of patients. 

FIRE PROTECTION: 

There is an organized fire brigade, the members of which are 
attendants and employees. They are given fire drills and in- 
struction in the actual handling of the apparatus. A hose car- 
riage, holding 250 feet of 2-| inch hose, which is placed at each 
ward building, in addition a hand fire extinguisher is located in 
each hall way and six buckets containing water in each ward. 
Water pressure is sufficient to throw a one-inch stream to the 
second story, which can be increased by the use of a fire pump. 
The stairways are wide and constructed of slate and metal. 
The second story sleeping rooms for patients are only nineteen 
feet from the ground. A fire department has been organized, 



4^ 

consisting of a chief marshal and ether officers, and a set of 
rules and instruction is published, on which they are examined. 
There is also a fire alarm whistle, regarding which they are also 
instructed. 

VENTILATION: 

The system of ventilation is by slow speed steam engine, large 
steam coils and fan under each building. In the winter the 
fan operated by the engine forced fresh air over the steam coils 
and through shafts into the dormitories. In the summer the 
fans simply force the fresh air into the dormitories. There are 
fans operated by electric motors in the attic rooms of each 
building for the purpose of pumping out the vitiated air. 

CAPACITY: 

600 men and 200 women. Total, 800. 

POPULATION: 

1906, 597 men and 202 women. Total, 793. 
No private patients. 

PER CAPITA COST OF MAINTENANCE: 

12.995 per week. 

DEATH RATE: 

12 men; 5 women. Total, 17. 

PERCENTAGE OF DEATHS: 

2.13 per cent. 

NUMBER OF DISCHARGES, 1906: 

2 women. 

1 man. 

Unimproved, 2 women. 

Improved, 1 man. 

During the year 1906 there was a daily average of 3 women and 

four meD sick, confined to bed, and a large number of patients 

suffering from minor ailments. 



49 

SALARY OF SUPERINTENDENT : 

$3,000. 

Two physicians on staff in addition to Superintendent. 

First Assistant, salary, $95 per month. 

Second Assistant, salary, $75 per month. 

No nurses named as such employed in institution. 

ATTENDANTS: 

Salary, $18 to $35 per month. 

Male — Number, 40. 

Several doing special work, $40 per month. 

Hours employed from 5 A. M. to 6 P. M. and until 8.30 P. M. every 
third night. 

Female — Number, 9. 

Salary, $14 to $25 per month. 

Hours employed from 5 A. M. to 6 P. M. and until 8.30 every other- 
evening. 

NUMBER OF PATIENTS EMPLOYED AND CHARACTER OF 
EMPLOYMENT: 

During winter, average of 350 male patients employed. 

During summer, average of 400 male patients employed. 

Male patients engaged in farming, gardening, grading, painting, 
trench digging, road-making, brush and mattress making, wagon 
and cart making, in the greenhouses, assisting in the bake shop, 
tailor shop, kitchen, refectory, laundry, etc. 

An average of 170 women employed throughout the year sewing, 
mending, laundry work, and general housework. During sum- 
mer 71.25 per cent, of population employed and during winter 
65 per cent. 

The patients make the women's dresses part of their under- 
clothing, all of the men's underclothing, men's corduroy trousers 
and overalls, bed linen, table linen, towels, mattresses, scrub- 
bing brushes, farm wagons, carts, and wheelbarrows. They also 
make all the ice used about the institution. 

AYATER SUPPLY: 

The water supply is obtained from streams flowing through the 
institution's grounds. It is taken from the streams and con- 
veyed through two six-inch pipes to a reservoir, situated about 
one-half mile from the asylum. From this reservoir it is carried 
though a six-inch pipe to buildings. 

4 



50 

HEATING: 

Direct radiation is the system of healing in the Administration 
Building and all the buildings except the dormitories, which are 
heated by indirect radiation. 



SEWAGE: 

The sewage flows through an eight inch main a distance of 1,500 
feet by gravity to a small basin, where it passes through screens, 
which catch the solid matter and debris, the latter being raked 
oft*. From the small basin it is carried a few feet to a well having 
a capacity of 60,000 gallons, and it is then pumped through pipes 
and distributed over the surface of the farm, being used as a 
fertilizer and irrigant. 

Chronic cases only are treated. Therefore the care is largely 
custodical. Those who are in good physical condition are induced to 
work and great benefit has resulted. There are no convalescent or 
receiving wards. 

The Superintendent of this institution is Dr. S. S. Hill, who has 
been since 1897. He graduated from the Medical Department of 
the University of Pennsylvania in 1894, and has made a special 
study of mental diseases. 

This Institution was founded under an Act of Assembly approved 
June 22nd, 1891, and was intended for the care, treatment and 
occupation of the indigent chronic insane. The inmates are required 
to be those who have been insane for one year or more, and to be 
transferred from the State Hospitals and Almshouses and Poor 
Houses of the different counties of the State by direction of the 
Board of Charities. It was opened for the reception of inmates 
July 21st, 1894. 

This institution is peculiarly constituted from any other in the 
State, that is to say, the act under which it was incorporated pro- 
vides that it shall care for the chronic insane and also the method by 
which they shall be received from other asylums. 

The buildings are more modern in construction than any of the 
older institutions, which, of course, gives it great advantage. They 
are only two stories high. 

It is almost wholly constructed on the dormitory plan and is 
purely a custodial institution. 

While the patients incarcerated are chronically affected with in- 
sanity and little or no hope of final recovery is entertained, they are 
cared for in such a way that no bars are used in the windows, and, 
in fact, every means were extended to them for their employ- 



51 

nient and enjoyment that the clouded condition of their minds would 
permit. 

The dining of the patients, male and female, together is condemned 
and should be changed as soon as possible. They should be separ- 
ated. The male patients* should dine together and alone as well as 
the female patients, and the attendants should have their separate 
dining room. 

We therefore recommend that money be appropriated for the 
purpose of constructing a dining room which will enable male and 
female inmates to dine separately and also that money be approp- 
riated for the building of a dining room for the attendants. 

The management is such as commend itself to our attention. The 
system of ventilation is good. 

Most all of the State asylums have in connection with their build- 
ings extensive acreage and so has this one. We think the system of 
disposing of the sewage is bad. At the same time we are bound to 
say it is probably the best that could have been devised at the time 
the same was installed. 

The bill of fare of this institution attached to our report is good, 
with the exception of the fact that we think butter should be fur- 
nished with every meal. 

We find a great number of the inmates are employed in and about 
this institution, and that this employment is beneficial to the treat- 
ment of the patients. The Commission highly commend this method 
of treatment. 

It was testified before your Commission that a great deal of the 
manual labor around and about the farm and the dairy is carried on 
under a Superintendent trained in the art of farming by men and 
women who are chronically insane. 

We find no law upon the statute books which compels this institu- 
tion to advertise for supplies, and we recommend a law should be 
passed to this effect. 



52 



STATE INSTITUTION FOR FEEBLE-MINDED 
OF WESTERN PENNSYLVANIA. 



POLK, VENANGO COUNTY, PA. 



GROUNDS: 

Acreage, 1,122| acres. 
Under cultivation, 500 acres. 
Not under cultivation, 622-J acres. 

BUILDINGS, 40. 

NUMBER OF STORIES: 

Two stories excepting Administration Building, which is three 
stories. 

SIZE OF HALLS AND ROOMS: 

No uniform size of hall and rooms. Corridor connecting buildings 
in main group 14 feet wide. Day-rooms and dormitories about 
30 by 50 feet. 

FOR WHAT PURPOSE USED : 

MAIN GROUP. 

1 Administration Building. 
1 Teachers' Dormitory. 

1 Gymnasium. 

2 Dining Halls. 

1 Kitchen and Bakery Building. 

2 School Buildings. 

1 Industrial School Building. 
IT) Cottages. 

2 Clothes Buildings. 

All attached by connecting corridors. 



53 
DETACHED BUILDINGS: 

1 Hospital Building. 

1 Custodial Building. 

1 Cold-storage Building. 

1 Store House. 

1 Laundry. 

1 Power House. 

1 Horse Barn. 

1 Cow Barn. 

5 Farm Houses. 

BUILDING MATERIAL USED IN CONSTRUCTION: 

All buildings are constructed of stone foundation, brick super- 
structure, with floors of reinforced concrete and slate roofs, with 
the exception of the five farm houses which are frame, and the 
Connecting corridors which are of brick with slate roof, the floor 
being of wood on wood joists. 

All buildings are lighted with electricity and all rooms are lighted. 

DINING ROOMS: 

There are eleven Dining rooms. 

Two large dining rooms, one for boys and one for girls, in the 
main group are about 100 by 50 feet each with a capacity for 
500 each. 

Two smaller dining rooms for lower grade children in the cus- 
todial building are about 40 by 28 feet with accommodations 
for about 100 each. 

One dining room in the hospital building is about 15 by 20 feet, 
and will accommodate about 20. 

The remaining dining rooms are separate dining rooms for men 
and women employed, men and women nurses and officers. 

The male and female patients do not dine together. 

The male and female nurses do not dine together. 

There are no enclosed yards for the exercise of patients. 

FIRE PROTECTION: 

A number of employees are organized into a fire company. Stand 
pipes with hose attached to the same are located at suitable 
points within the buildings. There are outside fire plugs and a 
good water supply, also had fire drills which are practised. 



54 

VENTILATION: 

The buildings are ventilated largely by natural ventilation which 
is supplemented by ventilating shafts. A ventilating shaft six 
feet square is located in the centre of each cottage. 

THE NORMAL CAPACITY IS 900. 

THE PRESENT POPULATION IS 1,250. 

PRIVATE PATIENTS, 36. 

THE PER CAPITA COST OF MAINTENANCE is $180 per annum. 

THE PERCENTAGE OF DEATHS for 1906 was 50 per thousand 
or 5 per cent. 

THE NUMBER OF DISCHARGES FOR 1906: 

Improved, 92. 
Unimproved, 13. 

NUMBER OF PATIENTS SICK, 50. 

NUMBER OF PATIENTS CONFINED TO THEIR BEDS, 20. 

SUPERINTENDENT'S SALARY, $5,000. 

NUMBER OF PHYSICIANS ON STAFF AND SALARIES: 

First Assistnat, $1,200. 
Second Assistant, $1,100. 

NURSES: 

Male 

Number, 6. 

Salary, $28 to $35. 

Hours employed, from 5.30 A. M. to 9 P. M. 

Female 

Number, 21. 

Salary, $24 to $28. 

Hours employed, from 5.30 A. M. to 9 P. M. 

ATTENDANTS: 

Male 
Number, 14. 



55 



Salary, |2() to $28. 

Hours employed, from 5.-30 A. M. to 1\ M. 

Female 

Number, 30. 

Salary, $18 to $24. 

Hours employed, from 5.30 A. M. to 9 P. M. 

Nurses and attendants have about two hours relief every day. 
Two evenings each week they go off duty, at 7 P. M. One day 
each week they go off duty at noon and every other Sunday are 
off duty the entire day. 

The nurses sleep in rooms adjoining the inmates' dormitories. 

The male and female nurses have separate dining rooms. 

NUMBER OF PATIENTS EMPLOYED AS FOLLOWS: 







Boys. 


Girls. 


Total. 






4 

6 
86 
52 
47 

•S 
16 

3 




4 








6 






182 


268 






52 








47 






40 


43 






16 








3 






36 


36 






1 

17 
6 
16 


7 








17 








6 








16 












263 


258 


521 



Forty three per cent. (43 per cent.) of the population are employed. 

MANUFACTURING : 

Polk manufactures nearly all the clothing worn by the children in 
the institute, including underclothing, stockings, shirts, coats, 
trousers, caps, dresses, and shoes; also mattresses, brooms, rag 
carpet, door mats, baskets, hammocks and many articles of 
furniture. 

WATER SUPPLY: 

Pure water is obtained from springs from the wooded hillsides 
above the institution by gravity. 

HEATING SYSTEM: 



Buildings are heated by steam supplemented by protected fire 
places burning natural gas. 



56 
SEWAGE: 

The sewage empties into Sandy Greek, a stream already polluted. 

There is a convalescent and receiving ward. There are two re- 
ceiving cottages, one for boys and one for girls, each having a 
capacity of about 50. There are also two separate cottages, 
one for boys and one for girls, for those children most nearly 
approaching the normal. 

Dr. J. N. Murdoch is the Superintendent of this Institution and 
has been since it was opened in 1897. Prior to that time he was Ghief 
Assistant Physician at Dixmont. 

The State Institution for Feeble-Minded for Western Pennsyl- 
vania, located at Polk, Venango County, was founded under an Act 
of Assembly, approved June 3d, 1893. It is especially devoted to 
the care and training of idiotic and feeble-minded children, particu- 
larly children incapable of receiving instruction in the common 
schools of the State, but who may be improved by special methods 
of instruction. It was opened for the reception of inmates, April 
21st, 1897. 

It is in control of a Board of nine Trustees, appointed by the 
Governor. 

The work of instructing the feeble-minded, or, as they have been 
designated, the defective intellects, has been carried on along ex- 
perimental lines for the past fifty-five years in this country. 

The first work of the kind began in France about 63 years ago by 
Dr. Sequien, and after meeting with some success in his own country 
he consented to visit Massachusetts about fifty years ago, and the 
result of his efforts the first three training schools for feeble- 
minded or mental defective's were founded in this country. These 
were the parent institutions in the United States. 

The Pennsylvania Training School for Feeble-minded at Elwyn, is 
probably the first successful institution established under his guid- 
ance, although it is a serious question whether the one now located 
at Syracuse, originally founded in Albany, and one year later per- 
manently located at Syracuse, is the older of the two. 

Our investigations and observations upon this subject lead us to 
believe that the results obtained by reason of the establishment of 
these training schools are so highly beneficial to that class of people 
that the work should be continued even more earnestly in the future 
than it has in the past. 

There are two such training schools in the State at the present 
time. The one at Polk is the most modern of its kind in the world, 
and has been so pronounced by the best authorities in this and 
foreign countries. 

The buildings are constructed on what is known as the cottage 



57 

plan, are well lighted and ventilated, and connected with each other 
by corridors built on the ground level, one story high, and almost 
built of solid glass on both sides, and heated by steam. The inmates, 
to the number of fifty, occupy each cottage and were usually, in 
charge of a man and his wife, which experience has taught throws 
around the cottage life a homelike appearance and environment as 
much as possible. Education in common school branches of study, 
calisthenics, and labor, are the chief features of instruction. No 
parent with the proper conception of duty they owe their children 
would raise their families in idleness, either mentally or physically, 
and this example should be followed in all institutions. We can say 
with great gratification that this institution represents the highest 
type of its kind in the world. The inmates are well housed, fed, 
and clothed. Their worldly and spiritual education seems to be well 
looked after. The fact is, the place as a whole is conducted on the 
same lines of a well regulated family. Freedom is granted to 98 
per cent., resulting in no escapes worth mentioning. This speaks 
volumes for its management. Therefore, on the whole, we cannot 
too strongly commend this institution for emulation of others of its 
kind. 

While it it true the sewage empties into a stream already pol- 
luted the system should be changed for sanitary reasons and as an 
example to others. 

We find no law upon the statute books which compels this institu- 
tion to advertise for supplies, and we recommend that they should 
advertise for supplies; if necessary a law should be passed to this 
effect. 



5$ 



PENNSYLVANIA TRAINING SCHOOL 



ELWYN, DELAWARE COUNTY. 



GROUNDS: 

Acreage, 337 acres. 

Under cultivation, 100 acres. 

Not under cultivation, 237 acres. 

CAPACITY OF INSTITUTION, 1,000. 

POPULATION, 1,088. 

Private patients, 138. 

PER CAPITA COST OF MAINTENANCE, $175.96 per annum. 

DEATH RATE, 14.74 per 1,000 per annum. 

Percentage of death rates, 1906, 1.48 per cent, per annum. 
Number of patients discharged in 1906, 49. 
Marked improvement, 29. 
Slight improvement, IS. 
No improvement, 2. 
Cured, none. 
Restored, none. 

NUMBER OF PATIENTS SICK, 90. 

Male, 49. 
Female, 41. 

NUMBER OF PATIENTS CONFIXED IN BED, 20. 

Male, 14. 

Female, 6. 

There are no enclosed yards for exercise of patients. 

NUMBER OF BUILDINGS, 20. 

Main building (north and south wing) 3 stories high; main build- 
ing center, 4 stories high; north home, 3 stories high; Martin 



59 

Craft, 3 stories high; industrial building, 3 stories; carpenter 
shop, 1 story: (all the above are stone buildings). Girls cottage, 
4 stories high, brick; school house, 3 stories high, brick; teachers' 
cottage, 3 stories, stone; laundry, 3 stories, stone; engine room, 
1 story stone; mansard, 3 stories, stone; dorms., 4 stories, brick; 
manse, 4 stories, stone and brick; Hillside Home A, 4 stories, 
stone; Hillside Home B, 4 stories, stone; Chalet, 4 stories, 
stone; Smith cottage, 3 stories, frame; steward's cottage, 3 
stories, stone; Edgmont and Ridley, two 3 story farm houses. 
There are thirty dining rooms in the institute with a capacity 
ranging from 6 for the matrons and nurses to 225 for the boys. 
These rooms are of varying size and location. 



SALARY OF SUPERINTENDENT, $3,000 per annum. 

Two male physicians on staff, salary, |600 per annum each. 
One female physician on staff, salary, 1900 per annum. 

NURSES: 

Male, 29. Female, 96. 

Hours of employment for both male and female nurses from 5:30 
A. M. to 6 P. M., to 9 :45 P. M. on alternate days. 

• 

STEWARD'S MEN: 

Number 26. 

Female attendants' salary, $16 to $20 per month. 

Male attendants' salary, $20 to $25 per month. 

Male nurses and female nurses eat in allotted dining rooms of the 

buildings to which they are assigned. 
They sleep in bed rooms or dormitories of not more than six to 

one room, which rooms or dormitories are in their assigned 

buildings. 

SYSTEM OF VENTILATION: 

Elwyn depends in great measure upon window ventilation. 
The building named Chalet, Hillside Home B, Hillside Home A 

and Manse are supplied with the Baffle System. 
The school house, main building, and domus have air flues to the 

roof. 



60 
SYSTEM OF HEATING: 

Steam heating in all buildings except the steward's cottage and 
Smith cottage, which are heated by hot water. 

SEWAGE SYSTEM: 

The sewage is run over the fields by gravity when the ground 
is in condition to receive it. At other times it empties into 
Kidley Creek below the Borough Water Works. 

WATER SUPPLY: 

Consumption, 150,000 gallons per day. 

Supplied by Media Borough Water Works. 

Pumped by Media Borough Water Works to the institution's two 
basins. 

Capacity of basins: No. 1. 600,000 gallons. 

Capacity of basin, No. 2, 200,000 gallons. 

A well has been bored which seems to have ample supply of ex- 
cellent quality drinking water, which the institution expects 
to appropriate in the near future in place of present supply. 

FIRE PROTECTION: 

Some of the buildings have fire escapes, stairways of iron and 
stone construction, some bridgeways and also chain and rope 
escapes from third floors. Outside fire escapes. 

Besides the above means of escape each floor of all buildings is 
supplied with Stempel Fire Extinguishers, fire buckets filled 
with water and tools. 

The laundry is supplied with. sprinklers and fire hose connected 
with water under high pressure. As little demonstration as 
possible is made. 

Telephone communication with Media Fire House, which station 
can get to the institution in 15 minutes. Also bell and steam 
whistle signals with same. 

The children in the institution are distributed as follows: Ab- 
solute custodial cases, 252 — 130 boys, 113 girls. 

There are 83G children under training, 498 boys and 338 girls. Of 
these 490 — 296' boys and 202 girls — are in the manual and in- 
dustrial departments, and 338 — 202 boys and 136 girls — in the 
school proper. 



61 



The children in the industrial and manual departments are divided 
as follows: 





Boys. 


Girls. 


Total. 




6 
14 

4 
4 
14 
29 
S 
6 
14 
16 
4 
152 
9 
21 




6. 




9 


23 




4 






4 












29 






e 






6 




47 

IS 

16 

112 


61 
34 


Kitchen 


Sewing, 


20 

258 

9 




Grading" and read making-, 






21 






« 


296 


202 


498 



Percentage of population employed, 45.8 per cent. 

The following were manufactured at Elwyn for the year 1906: 

Pants, 578. 

Coats, 338. 

Night shirts, 510. 

Pillow cases, 715. 

Sheets, 1,175. "j 

Towels, 630. : 

Caps, 194. 

Overalls, 57. 

Dresses, 784. 

Shirt waists, 71. 

Wrappers, 9. 

Skirts, 497. 

Aprons, 969. 

Drawers, 706. 

Bodies, 200. 

Night gowns, 300. 

Chemises, 60. 

Bibs, 500. 

Mattress shop: 

Mattresses, 390. 

Pillows, 75. 

NATURE AND KIND OF TREATMENT ACCORDED TO 
PATIENTS: 

Patients are treated according to mental conditio!* and medi- 
cally according to individual needs. Much attention is also 
accorded hygienic surroundings, exercise and proper food. 

There is no convalescent and receiving ward. Admission patients 
are isolated in general hospital for ten davs. 



62 

Dr. Martin W. Barr is the Superintendent and is a graduate of 
the University of Pennsylvania in the class of 1882, and has been 
connected with the institution for twenty-one years. 

This institution was founded in 1854 as a private school in Ger- 
mantown, and in December, 1857, the present site was selected 
and the corner stone laid. 

Elwyn was incorporated by an Act of Assembly approved April 
7th, 1854. Patients are received from Eastern Pennsylvania. 

The institution is managed by a Board of Trustees, consisting of 
twenty members, the vacancies to which are filled by the Board 
itself. The Board, as established at first, was a private corpora- 
tion, and then applied to the Legislature for aid. 

The main buildings of this institution are antiquated and lack 
all modern improvements. They are bunched in such a way which 
makes them unattractive to the eye, and by their exterior construc- 
tion indicate just what they are, namely, that they were built many, 
many years ago. 

In method of construction and equipment in any way it cannot 
be compared with the institution at Polk. 

The Superintendent is an eminent specialist and is doing the best 
he can under the most trying circumstances. 

The children seem to be well disciplined and taught in schools, 
calisthenics and industrial trades. 

While this institution is of a semi-public character, of the total 
population of 1,088, all the patients are maintained by the State 
with the exception of 138. 

Nearly all the wooden floors are waxed or oiled instead of 
scrubbed, and when considered with the fact that the original con- 
struction in the old buildings are not on the line of a fire proof 
character, makes them highly combustible and subject to destruc- 
tion in case of conflagration. 

With few exceptions these buildings cannot be altered or changed 
into the modern, and if the State proposes to continue its wards 
in the care of this institution, we would recommend that the orig- 
inal group of buildings should be gradually torn down and replaced 
by the up-to-date and the most modern ones, such as already have 
been erected at Polk or are now in the course of erection at Spring 
City, Chester County. 

The ventilation, sunshine, air, and equipment in these old build- 
ings cannot compare with those of modern construction. Many of 
the buildings are three and four stories hig v h, which, of course, are 
not in keepmg with this thought. 

There is no nurses' home for either females or males, and they are 
compelled to live in buildings to which they are assigned with their 
patients. 



63 

A few building^, modern in construction, however, have been 
erected, and are, of course, improvements upon the old style. 

We found here several inmates who are residents of other states. 
While the institution being of a semi-public character can take 
patients from wherever it deems proper, at the same time, in view of 
the over-crowded condition of other institutions in the State, and the 
fact that the State has appropriated money since its incorporation 
and is now appropriating money for improvements and new build- 
ings, Ave cannot commend this feature of administration that prefer- 
ence should thus be given. Preference should be given to the State's 
wards. 

We recommend that money appropriated to this institution for 
new buildings shall provide that they must take the place of those 
ancient and antiquated ones which should be torn down, and that 
tlfe method of construction to be adopted should be the one fol- 
lowed, as we have already designated, namely, at Polk, or the new 
institution for feeble-minded and epileptics, now in course of con- 
struction at Spring City. 

We cannot commend the system of drainage adopted, as the sew- 
age empties into a public creek. Sooner or later this must receive 
attention and other means be provided for its disposal. 

Although the Act of June 28, 1885, P. L. 170, provides that the 
Superintendent for two successive weeks and yearly thereafter 
the same length of time commencing on the first Monday in April 
shall advertise in three newspapers of general circulation for bids 
to furnish all needed supplies for the year beginning June 1st next 
ensuing, and to furnish on application itemized lists of the kind 
of supplies required and to award the contract for the same to the 
• lowest and best bidder, taking security for the faithful performance 
of the contract, the same has not been complied with. 

We recommend that the management should strictly observe the 
provisions of this Act. 



64 



FINDINGS AND RECOMMENDATIONS, 



INSANE INMATES. 



There were on September 30th, 1906, 14,283 insane persons of 
all sexes located in the different State and County care institutions 
of the State of Pennsylvania. That is, in the six particularly State 
institutions enumerated, and twenty institutions in which are cared 
for the insane of one or more Counties in contradistinction to State 
institutions. * 

Statistics show an increase at about the rate of 500 a year. 

The percentage of insanity of the magnitude that is presented 
to the consideration of this Legislature is sufficient to attract the 
attention of all our people. 

As we consider this vast population of mentally irresponsible 
beings it causes us to reflect seriously on the proper management 
and care of so many unfortunates. 

We are of the opinion that the State cannot do too much to 
further the inquiries leading to an investigation into the cause of 
the large increase of insanity not only in the State of Pennsylvania 
but as we find it occurring throughout the country. This should 
be done in the hope that there may be found in this advanced age 
of medical science remedies which when applied may to a more or 
less degree prevent such an enormous increase of this terrible dis- 
ease or disorder of the mind. 

Pennsylvania for over a century has occupied a high and honor- 
able position in the science of medicine, under which this depart- 
ment comes. To maintain this standard it must improve the man- 
agement of its State institutions for the care and treatment of the 
insane. The one serious obstacle in the way of this improvement 
is the rut or mannerism which appears to exist in several of the 
institutions to-day, and in all of them only a short time ago. 
There appears to be no effort on the part of the management 
to keep abreast of the improvements of modern times. In all the 
arts and sciences the advances made are simply astounding, and yet 
in this where the reason of the human being is dethroned, which 
should be the most important of all considerations, the least im- 
provement has been made. To remedy this, it is necessary that the 
Superintendent and Boards of Trustees of the different institutions 
comprehend and understand more fully the duties incumbent upon 
them. 



65 

It iias not been our purpose throughout this investigation to re- 
flect discredit upon any one or to criticize harshly the management 
of any institution, but there is a duty imposed upon us which re- 
quires that the truth must be told in order that hereafter the best 
results may be obtained. Therefore we purpose now to take up 
and discuss the many features which we consider important with 
such recommendations as we deem advisable to make. 

We have sought to arrange the subjects for discussion together 
with our findings and recommendations in alphabetical order. 

ACREAGE: 

Most all of the State asylums have in connection with their 
buildings extensive acreage, none of them having less than 370 
and one of them as high as 1,100 acres; yet, notwithstanding this 
liberal supply of land, the institution management do not appear 
to have taken advantage of the opportunities offered them for exten- 
sive farming. It appears to us that with such fertile lands as sur- 
round a great majority of these institutions, larger and a greater 
variety of crops should be raised each year, and with an inmate 
population of from 1,200 to 1,500, and an acreage of a thousand, 
it seems wanting in business tact to have to purchase milk or 
butter or any of the farm commodities that can be so easily raised. 
It is certain that a comparatively large percentage of the inmates 
can work, and would be better physically and mentally if kept em- 
ployed during the greater hours of the day. Farming work is 
the most safe and suitable for all forms of mental derangement 
and hence two important desideratums would be conserved by keep- 
ing the minds as well as the bodies of those patients active. The 
benefit, physical and mental, which is always the first considera- 
tion, would be vastly improved in a heavy percentage of cases and 
then, too, the State would derive the benefit, from their labor, which 
it has a just reason to expect. Where inmates are able, and it 
is to their benefit to be kept employed, we cannot see any good 
reason for having them while away the hours of the day in in- 
dolence and sloth. 

Your Commission, therefore, most strenuously recommends the 
greater extensive working of the land surrounding these institu- 
tions, that the business tact and energy that make the successful 
farmer conspicuous among his kind should be carried into execu- 
tion here, and that in the future nothing in the line of produce 
that can be raised upon the soil of the institution be purchased. 

ADVERTISEMENT FOR SUPPLIES: 

As we have already stated, the institutions at Danville, Dixmont, 
Warren and Elwyn do not advertise for bids for supplies and award 
5 



66 

the contracts to the lowest and best bidder, as required and in ac- 
cordance with the acts of assembly hereinbefore mentioned, but 
on the contrary, invite bids on schedules furnished by the steward, 
or go in the open market and make contracts as in their judgment 
may be deemed advisable. We cannot approve of this method, 
as we are of the opinion that the acts requiring advertisement, in 
order that fair competition may be had, should be strictly com- 
plied with. 

We cannot find upon the statute books any law which requires 
the institution at Polk and Wernersville to advertise for bids for 
supplies. We therefore recommend that the appropriations made 
to these two institutions should contain a condition that adver- 
tisements must be made for bids for the furnishing of all supplies. 

BOARD OF PUBLIC CHARITIES: 

The Board of Public Charities was organized under the Act of 
April 24, 1869, P. L. 90, which provided that the Governor should 
appoint five Commissioners, who, together with a general agent 
and secretary, should constitute a Board of Public Charities. They 
were to be sworn and organized by the election of a president, and 
meetings held once in every three months. 

The Commissioners receive no compensation for their services, 
but are allowed traveling and other necessary expenses. Any Com- 
missioner neglecting to perform his duty for six months is pre- 
sumed to have resigned and the Governor shall appoint for his 
unexpired term. 

Under the Act of April 9, 1873, P. L. 68, two additional Commis- 
sioners were authorized to be appointed. This Act also provides 
that the president and any two members of the Board shall consti- 
tute a quorum. The general agent and secretary receive a salary 
of $3,000 per annum. The commissioners and general agent are 
vested with power "at all times to look into and examine the con- 
dition of all charitable, reformatory or correctional institutions 
within the State, financially and otherwise, to inquire and examine 
into their methods of instruction, the government and management 
of their inmates, the official conduct >of trustees, directors and other 
officers and employees of the same, the condition of the buildings, 
grounds and other property connected therewith, and into all other 
matters pertaining to their usefulness and good management." They 
shall have free access to the grounds, buildings, and all persons 
connected with the same are required to give such information 
and afford such facilities for inspection as the Commissioners may 
require, under a penalty. 

The Commissioners, by themselves or their general agent, are 
authorized and required, at least once in each year, to visit all 



67 

the charitable and correctional institutions of the State receiving 
State aid, and ascertain whether the moneys appropriated have 
been economically and judiciously expended; "whether the objects of 
the several institutions are accomplished" and the laws fully com- 
plied with; whether all parts of the State are equally benefitted 
by them, and to make annual report to the Legislature of their in- 
vestigation, together with such other information and recommenda- 
tions as they may deem proper. 

They shall require their General Agent, at least once in every 
two years, to visit and examine into the condition of the City and 
County jails, or prisons, and alms or poorhouses, with like authority 
to make inquiry regarding the management, etc., to report to the 
Legislature the result of the examination. The persons in charge 
of these institutions are required by law to make report annually 
to the general agent of their condition as he may prescribe. 

Institutions receiving or those desiring to receive State aid, must 
give notice to the general agent on or before the first day of No- 
vember in each year of the amount of any application for State 
aid. The general agent must inquire into the ground of such request. 

Members of the Board have power to administer oaths in exam- 
ining persons connected with any of the inquiries authorized to 
be made. 

No member of the Board shall be interested directly or indirectly 
in any contract for building, repairing or furnishing any institutions 
which they are authorized to visit or inspect; nor shall any trustee 
or other officer of any of the institutions be eligible to the office of 
Commissioner or general agent. 

The Board is required to make report annually to the Legisla- 
ture of their "doings" and may appoint persons to act without com- 
pensation as visitors of the poorhouses and other institutions, and 
refusal to permit such persons to examine and inspect these in- 
stitutions is punishable by fine. 

The Board have the power to remove insane patients to State 
institutions from county or district almshouses, or in the care of 
any person under the direction of the poor directors of any district, 
if in their judgment they cannot receive proper treatment, such 
persons to be maintained at the expense of the district from which 
said person is transferred. 

The Board have supervision over all houses in which any person 
of unsound mind is detained. The Act of May 8, 1883, Page 22, 
provides for the appointment of three additional members by the 
Governor, and also that the Governor, upon sufficient cause, may re- 
move any member from office. The Board may appoint a committee 
of five to be called a Committee on Lunacy. Said committee is to 
choose a chairman and secretary to serve for one year. The sec- 
retary receives a salary of three thousand dollars per annum 



68 

and necessary incidental expenses. The duty of this committee 
is to report annually to the Board the condition of the insane in the 
State, the management and conduct of the hospitals, public and 
private almshouses, and all other places in which the insane are 
kept for care and treatment, or detention. 

The Board has the power to make rules and regulations for their 
own government and the secretary, and the Committee on Lunacy 
shall make an annual report to be published with that of the Board. 

The Bioard have the power from time to time, with the consent 
of the Chief Justice of the Supreme Court, and of the Attorney 
General, to ordain rules and regulations of the following matters: 

1. For the licensing of all houses or places for detention of in- 
sane, except jails; from time to time, may "exempt any particular 
hospital established by the State, or under any municipal authority, 
or any eleemosynary institution from the obligation to apply for or 
obtain a license." 

2. Regulations to insure the proper treatment of persons de- 
tained. 

3. Regulations of the forms to be observed warranting the com- 
mitment, transfer or custody and discharge, etc. 

4. Visitation of all houses and places licensed under the Act. 
etc. 

5. The withdrawal of such licenses, etc. 

6. Reports and information to be furnished by the management 
or managers of all houses, etc. 

7. Regulations as to the number of persons that may be de- 
tained, and the accommodations to be provided, food, clothing, etc. 

There shall be appointed boards of visitors of all houses or places, 
one for each county, and women may be members. 

"The Board shall from time to time provide for an effectual visita- 
tion 'of all persons confined as insane" and shall make rules to in 
sure admission of proper visitors. 

Statements required under law to be furnished at the time of the 
reception of patients in the various institutions, shall be forwarded 
by mail to the Committee on Lunacy within seven days from the 
time of reception thereof. The Committee on Lunacy shall receive 
notice of the insane sent to hospitals, and also be notified of all dis- 
charges by the Court of the insane criminals within seven days 
thereafter. The Committee may compel the discharge of any person 
detained as insane, except persons committed after trial and con- 
viction for crime, or by order of Court. 

This, we believe, about constitutes a general review of the duties 
and powers imposed upon the Board of Public Charities by the 
various important acts of assembly which have been passed since 
the time of its organization. When this Board was created in 1869, 



69 

it might have been the best system of control which at that time 
could have been conceived. We are satisfied that in view of the 
great advancement made by the adoption of modern methods in 
the care and treatment of the insane as it exists to-day, this Board 
is in no way constituted by which it can properly supervise, direct 
and control the various institutions committed to its care as they 
deserve. In other words, this Board is required to meet four times 
a year. The members serve without compensation. They reside 
in all parts of the iState, and with the exception of two men, who 
are paid small salaries, there are no other employees in the de- 
partment except two clerks. It cannot be expected that active bus- 
iness men should devote their whole time and attention, <or any 
great amount thereof, to such work without compensation, as of 
course their own private affairs must command the greater portion 
of their time. To continue as an advisory board to an officer ap- 
pointed by the Governor in whom is lodged by law power to act 
with proper compensation paid for his services, and authority to 
employ such help as is required, would certainly be at least a great 
improvement. 

To act in the capacity of a mere advisory board, attending a few 
meetings a year, and making periodical visits to the institutions, 
perhaps, when the Board was created, constituted a control over 
the few institutions that existed at that time, which, in all prob- 
ability was sufficient. Then there were about 150 public and 30 
private institutions in the State, as compared with over 500 that 
exist to-day. It must be plain to the mind of every thoughtful citi- 
zen that such a system of control is antiquated and insufficient and 
should be improved. No such system of control would be enacted 
into law by the Legislature of to-day. We do not believe, consti- 
tuted as at present, it is able to apply good business principles 
in the administration of the affairs of the various institutions, in 
order that the inmates can receive the care and treatment they de- 
serve, and, at the same time guard the interests of the State against 
imposition, extravagance and waste. 

The Commission is of the opinion that these institutions require 
constant inspection and examination and that somewhere authority 
should be vested by which superintendents should be made to carry 
out the most modern ideas instead of their own if they are opposed 
thereto. 

Their books should be carefully audited at regular stated in- 
tervals. The moneys expended for repairs should be minutely spec- 
ified and set forth. The care and treatment of the inmates should 
be accurately and definitely described. In other words, a constant 
supervision should be exercised over all having care of the insane, 



70 

penal institutions, reformatories and all public charities to which 
State aid is extended. 

To cite an instance showing the lack of power to control these 
institutions as vested in the Board of Charities, who is there in 
authority that could say to any one of them, "you must erect the 
temporary buildings out of the money appropriated for that purpose 
by the Legislature of 1905" if the Superintendent and Board of 
Trustees say "we will not do so?" as some did, despite the action 
of the Legislature. Where is there lodged any power or authority 
to cause proper ventilation to be made where the Superintendent 
and the Board of Trustees of an institution refuse to make it? 
Where is there any power or authority vested by which the system 
of sewage should be changed or the water supply remedied if the 
Superintendent and Board of Trustees do not approve of it? And 
so we might go on indefinitely, and cite instances where direct State 
authority should be exercised in matters constantly occurring, but 
which does not exist to-day. 

The standard of custodial care and treatment must be raised 
higher and higher until it reaches the best. This, in our judgment, 
will not be accomplished until the State assumes a greater con- 
trol of the administration of the affairs of the institution. This 
is a problem that must be worked out. 

In an endeavor to place the administration of the affairs of this 
class of institutions upon a business basis, and that a step shall be 
taken to lodge authority somewhere in order that a higher standard 
of methods of custodial care and treatment may be introduced 
and maintained in the future, we respectfully recommend the pas- 
sage of the bill hereto attached, which will unquestionably provide 
an improvement on the present system because it will concentrate 
authority, it will lead to a uniform system of administration, to 
the correction of abuses, and to an economical expenditure of the 
vast sums of money annually appropriated by the State for these 
charities. 

BOARD OF TRUSTEES: 

We feel that we cannot too emphatically call attention to the 
fact that the Board of Trustees of these institutions should be in 
close touch with the Superintendent in the management of their 
affairs. At some of the institutions we were met by members 
of the Board, and in others none were visible. Somebody is cer- 
tainly responsible for the failure of the advancement and improve- 
ment of many of the institutions to which we have particularly 
called attention. We cannot speak personally of the individual 
knowledge possessed of the operation and management of the affairs 



71 

by any single member of any of the boards of the institutions which 
they may represent, but we are constrained to say that if the mem- 
bers of the Board would actively interest themselves and emphat- 
ically make known to those in authority the ancient methods in 
operation because of lack of modern facilities to introduce the most 
up-to-date ideas, the various institutions referred to would be in 
much better condition to-day. 

BOOK-KEEPING: 

We do not find two institutions wherein the same method of 
book-keeping has been adopted. We therefore recommend that a 
uniform system of book-keeping should be inaugurated and that 
blank schedules for supplies should be uniform and alike in every 
one. There should be a book distributed from a central bureau 
containing all information with regard to blanks, schedules, store- 
house supplies, books, farm accounts, supply accounts, income ac- 
counts, purchasing accounts and all others used in the most modern 
method of book-keeping. Blanks also should be furnished upon 
which reports should be made to the proper authority in detail and 
at length every quarter or half yearly, so that the Board of Control 
can be in close touch therewith at all times. 

BUILDINGS: 

In support of our recommendation that those institutions built 
upon anpient lines and equipped after the old monasterial asylums 
should be torn down, because modern treatment and care cannot be 
administered with buildings thus constructed, we refer to the tes- 
timony of the gentlemen who were called to give evidence as expert 
alienists, Dr. T. C. Fitzsimmons, Dr. William P. Spratling and Dr, 
J. Robert B. Lamb. Quoting from the report of Dr. H. L. Orth, 
the Superintendent of the Pennsylvania State Lunatic Hos- 
pital, at Harrisburg, in which he says "for years the buildings of 
this institution have been condemned as unsatisfactory, as not 
adopted for their purposes, as unhealthy on account of the saturated 
(with water) condition of the walls, and of course not desirable for 
the care of our inmates. • 

"After careful inspection of the more modern hospital buildings 
* * * plans were made for new groups of buildings to take the 
place of those now in use, constructed in 1850. The responsibility 
connected with the designing of new buildings is grave, the advances 
made in hospital construction within the last two decades have 
overthrown our early ideas, and while the block plan, with its many 
stories, has given way to the cottage system, there are certain ele- 
ments in both that can be used to advantage. These are sanitary 



72 

and aesthetic and bear upon the bodily and mental welfare of the 
patients subjected to their influences. From a sanitary point of 
view the requirements for a general hospital and a hospital for 
the insane are similar, but for the insane is required a quality of 
structure that the need of the bodily sick does not demand, and 
surroundings that admit of their treatment through the external 
senses. 

"Until recent years, asylums so called, have been constructed 
to secure compactness and economy of administration, linear build- 
ings with wings on each side of a central administration building, 
three or four stories in height, with long corridors, with bed rooms 
on both sides, the corridors utilized for every day use by patients, 
can be seen in every direction, in fact, our own is typical. So-called 
improvements have been made from year to year, but without change 
of type. 

"The disadvantages of the linear plan have been recognized as 
our knowledge and treatment of insanity has advanced. The de- 
pressing influence of the dull monotonous structure retards im- 
provement or recovery, while variety and opportunity for sub-di- 
vision and classification should improve recovery, and an abrupt 
departure from linear to cottage plans have resulted, and the asylum 
village has been evolved, where often every ward is a separate 
building without any connection to its fellow. In the variable cli- 
mate of this country this feature is not desirable, and authorities 
are beginning to realize that certain features of the linear plan 
can be advantageously combined with the cottage. 

"Since the erection of the branch buildings, especially on the 
male side, the ventilation has given much trouble, and during the 
early spring and late summer, diarhoeal and dysenteric diseases 
have prevailed, inexcusable in a new building, as they are generated 
by filth due to imperfect ventilation. Several attempts have been 
made to correct the trouble with apparent success as far as odors 
were considered, but the intestinal troubles continued. The placing 
of steam coils in iron chests in the attics with outlet on roof and 
running large ventilation pipes from closets to these chests, thereby 
securing continuous downward ventilation through the closet has 
secured results. There has not been a single case of the dysentery 
in the wards since the introduction of this apparatus." , 

Dr. Orth deserves great credit as being the first superintendent 
in Pennsylvania who has had the courage to impress upon the Leg- 
islature the importance of tearing down the old and ancient build- 
ings and by replacing them with those of modern type. We agree 
with him that "for the suppirt of each insane patient, with his at- 
tendant, in a hospital, to give air, space and exercise room, it is well 
established that there should be one-half acre of ground." We recom- 



73 

mend that all institutions should acquire at least this much as soon 
us possible. 

CHILDREN. 

While it is to be very much regretted that the testimony shows 
that many children who have been adjudged mental defects have 
been committed to these institutions at the same time, there was 
no other place in which they could be cared for, owing to the over- 
crowded condition of the institutions wherein children have been 
committed. On the completion of the Spring City institution for 
feeble-minded and epileptics for children sufficiently to at least ac- 
commodate several hundred inmates, on or about the first of August, 
1907, we recommend that attention should be given, first, to these 
children referred to, which are now incarcerated in insane asylums, 
and their removal accomplished as soon as possible. 

COMMITMENT OF INSANE: 

The Commission is of the opinion that no person should be de- 
clared insane upon a petition and the certificate of two physicians 
of five years' standing, one of whom shall swear to the same before 
a committing magistrate, as now provided by law. A man about 
to be deprived of his liberty, whether rightly or wrongly, should 
have the right to appear in a court of justice, and his case properly 
heard on such evidence as may be produced. We know of one in- 
stance, as will appear in the testimony of Dr. Orth, Superintendent 
of the State Hospital at Harrisburg, that he discharged three per- 
sons in one year as soon as each Avere committed, because he de- 
clared they were not insane. We hold that the most careful safe- 
guard should be thrown around an unfortunate mentally -afflicted, 
whose incarceration is applied for. Such person should have his 
day in court — that is to say, a Judge, after passing upon the papers 
and examining the person to be committed, hearing such testimony 
as might be offered by both sides, determine the facts in the case 
and make his ruling thereon accordingly. This can be done in Cham- 
bers or any place the Judge may see proper to sit for the hearing. 
Also at the same time, in order that they might not become de- 
pendents of the State financially, careful inquiry should be made by 
the Court into such person's present pecuniary affairs, together 
with that of those who are responsible for their care that a decree 
can be entered for the payment out of any moneys which are shown 
to be available, if such there may be found, for the maintenance of 
such insane person, or an order made upon such persons who under 
the law might be responsible for their maintenance if any such be 
ascertained. 



74 

We are of the opinion that the law as it stands to-day fixing the 
responsibility for the care and support of those financially able to 
pay who are related to such insane persons is not sufficiently en- 
forced. At the present time the State supports and maintains a 
very large proportion of its insane patients in its hospitals, although 
such patients may have relatives abundantly able to provide for 
them. There is no reason why a person, if financially able as are 
responsible under the law, possessed of sufficient means, should not 
maintain such inmates. 

We are of the opinion that the Act of 1887, does not throw the 
proper safeguards around the commitment of such persons, and 
therefore recommend the passage of a proposed act hereto attached. 

COUNTY INSANE INSTITUTIONS: 

While it was not within the line of duty of this Commission to 
inquire into the condition and management of the county insane 
asylums, of which there are twenty, and therefore will not go 
into details with regard thereto, at the same time, the expert 
testimony called in other matters alluded to this method of the 
care and treatment of the insane. Basing, therefore, our judgment 
upon this testimony and from our personal knowledge and informa- 
tion obtained from others, we are of the opinion that these county 
institutions, with the exception, perhaps, of those located in the 
larger counties, Philadelphia and Allegheny, should be abolished, 
and all inmates removed therefrom to state institutions. 

EMPLOYMENT OF INMATES: 

The one great factor in the treatment of the large majority of 
insane inmates is employment of the body and mind, and this 
thought cannot be too strongly impressed upon those in authority. 

We refer especially to the testimony of the experts with which 
we will not go in detail. 

Those capable of employment in some institutions are larger in 
percentage than in others. In some instances this is no doubt due 
to the management. If the inmates can be trusted and are capable 
of performing labor in the fields and open air they should be per- 
mitted and urged to perform such employment. Those who them- 
selves cannot be trusted, but who are capable of employment on 
the inside should be thus employed. Separate buildings such as we 
find one at Warren, wherein women are employed in the arts such 
as pottery, sculpturing, painting, pyrography, etc., should be con- 
structed and attached to every institution in the State. In many 
of the institutions we visited, able-bodied men and women were idly 



75 

lounging in the different halls on benches and on the porches. Some 
employment for the mind and body would have been far better 
for each of them. It has been tritaly said that an idle mind is the 
devil's workshop. If that applies to a sane, sound reasoning mind, 
why does it not doubly apply to those incapable of reasoning? 

It is a weakness of human nature more commonly found among 
the class we find in an institution not to do anything that they are 
not compelled to do, and by this word "compelled" we do not mean 
that any harsh or unusual methods should be adopted to compel 
them to do that which they do not want to do, but that the tact and 
ingenuity of the governing body should devise ways and means 
of inducing inmates to labor and to do so cheerfully and con- 
tentedly. This is what management means. If the officials 
are not qualified to meet every emergency that arises in these in- 
stitutions, they cannot be said to be occupying their proper posi- 
tions. So while it is true that many of these people prefer to re- 
main in idleness, yet, with the proper kind of persuasion and reason- 
able inducement they can be taught to be kept busy during many 
hours of the day and thus add to their mental and physical improve- 
ment. 

In fact, the question of employment of these poor afflicted crea- 
tures has been so impressed upon our minds that we have given 
the subject grave consideration. 

The management of every institution complain that by reason 
of the law upon the statute books preventing the manufacturing 
and sale of articles produced in these institutions because of its 
competition with outside labor they are unable to give employment 
to all of their inmates who are competent to thus be so engaged. 

There was general approval given to the New York law by those 
in authority which provides for the manufacture and production 
by the inmates of such institutions articles and products that can be 
exchanged or sold to other institutions in the State of a like or 
similar character. 

We therefore strongly appeal for the passage of the proposed act 
hereto attached. 

To give many of them employment such as we have here desig- 
nated will mean in many cases such improvement of body and mind 
that they may be discharged from their environment and again 
return to their homes and friends. 

A most charitable and considerate view of this recommendation 
must appeal to every one. 

To give an idea of what can be done, we were told by the Super- 
intendent of one hospital that he had labor sufficient among his 
inmates to make all the shoes that could be used by all the institu- 
tions in the State. 



76 



FINANCIAL RESPONSIBILITY OF INMATES NOW IN INSTI- 
TUTIONS AND THOSE ON WHOM THEY ARE DEPEND- 
ENT. 

We haA T e endeavored to ascertain, as far as possible just who those 
inmates are in the different institutions, and whether they have 
money or property of their own to maintain them, or who, under 
the law, have such next of kin as are responsible financially to pay 
for their support. 

This has involved the mailing of over 10,000 letters of notification 
to those responsible for the commitment of each inmate as far as 
they could be ascertained. A list of the same together with other 
facts will be submitted to you before the end of your session as a 
supplemental report hereto. 

These communications require a reply to the Commission setting 
forth the names and the addresses of all relatives and their ability 
to pay. 

Before taking up this procedure we found that the various insane 
inmates were maintained at an approximate per capita cost of $3.75 
a week, and of this amount $1.75 was paid by the county and $2 
by the State. In many cases the Commission found that the counties 
have protected themselves so far as the payment of the $1.75 is 
concerned, and compelled the relatives of those committed to reim- 
burse the county, but no action whatever is taken by the State 
to have the State reimbursed for her outlay for the support of such 
inmates. The result is that nearly one million dollars is thus paid 
annually by the State, of which we believe at least 60 per cent, 
of this amount, if proper demand was made and in case of refusal 
by legal proceedings, could be collected. In the cases where the 
$1.75 has been and is now being collected by the counties, we find 
that in a large number of them both the county and the State 
have been imposed upon, and relatives that are quite capable of 
paying this charge for their support are not doing so, and thus 
the burden is imposed upon the State and her taxpayers. 

In many cases we have found that lunatics themselves have 
estates to be sufficient in amount to pay all the charges for their 
maintenance and support. And in this connection we desire to state 
that in Philadelphia county when this matter was brought to the 
attention of the attorney who was the solicitor for the guardians of 
the poor that proceedings were instituted in the court by rule on the 
relatives of certain inmates confined in the Norristown institution to 
appear and show cause why the court should not make an order upon 
them for the payment of the charge, and upon hearing in these cases 



77 

the total amount collected was many thousands of dollars and actual 
orders were imposed amounting to many thousands of dollars more. 

When these proceedings were first begun, the amount paid to 
the City of Philadelphia through this one institution alone was 
$4,000, and to-day by reason of these proceedings the said city is 
receiving over $40,000 per annum. These figures were taken from 
'the report of the present Solicitor of the Guardians of the Poor 
of the City of Philadelphia, William T. Connor, Esq. 

We recommend that every County Solicitor in Pennsylvania shall 
follow this precedent and institute similar proceedings in the 
county courts in order that an inquiry may be made upon the facts 
and the responsibility fixed. 

Under the Act of Assembly hereto attached providing for the 
creation of a Board of Public Charities, etc., we have recommended 
the appointment of an attorney whose business it shall be to see 
that the interests of the State in this regard shall be carefully 
looked after. 

FIRE PROTECTION: 

In the statement of facts made regarding each institution in this 
report, the system of fire protection in operation in each institution 
is set forth. So far as the old institutions are concerned, none are 
fireproof. In case of fire thousands of lives would be imperilled and 
in jeopardy. 

We therefore urge upon the Superintendents and Trustees to 
have constructed, wherever possible, fireproof passageways and 
such other appliances in addition to what they already have, in 
order that more protection might be given until their old buildings 
are taken down and transplanted by the new and modern ones. 

FOOD FURNISHED INMATES, ATTENDANTS AND NURSES: 

In the majority of the institutions, the food furnished the inmates, 
attendants and nurses, seemed to be good. 

Your Commission was present in each institution while one meal 
was being served. 

Upon a close examination of the bills of fare, which are hereto 
attached, we find that butter is not served at every meal in every 
institution. We also find that in many of them dessert at dinner 
is served occasionally. 

We cannot commend this hard and fast rule, as we think that 
butter should be served at every meal, and that at least five times 
a week dessert should be served at dinner. Whenever fruit is 
served, which ought to be as often as possible, we recommend that 
it should be at the breakfast meal. 



78 
INEBRATES: 

In many of the institutions, as will be seen by the testimony, we 
found persons committed by magistrates under the Act of 1903 
for inebriety. Heretofore there has been no provision made in 
any State institutions for the reception and treatment of this class 
of patients, and they are therefore confined in the wards where 
the quieter cases of insanity are housed. 

Persons, as a rule, committed to these institutions for inebriety, 
within a very short time recover their senses and resume the en- 
joyment of good health, and to longer maintain them in a ward 
of an institution for the insane surrounded by a class of inmates 
referred to we consider inhuman and subject to the severest crit- 
icism. 

We are of the opinion that the Act of April 16, 1903, entitled, 
< fl An Act to authorize and provide for the commitment of persons 
habitually addicted to the use of alcoholic drink or intoxicating 
drugs to a proper hospital or asylum, for restraint, care and treat- 
ment, should be so amended that the power of commitment should 
be vested in a Judge of the Court of Quarter Sessions in chambers, 
only upon petition and hearing, and that authority should be vested 
in the Superintendent of the institution, of which he shall be an 
inmate, to discharge him whenever in his judgment he deems that 
he has recovered from the effect of his inebriety. 

We, therefore, have redrafted the Act of April 16th, 1903, in- 
serting the amendment herein specified, and recommend its passage 
by your honorable bodies. We exceedingly regret that we cannot 
recommend that the word "asylum" should be stricken out of the 
title, and also wherein it appears in the bill. This we cannot do for 
the reason there is no other place to send them excepting the 
jails. 

There has been introduced into your honorable bodies a bill pre- 
pared by the State Medical Society which provides for the erection 
or a hospital for this class of patients. We cheerfully endorse the 
movement which has taken up this subject, and strongly recommend 
the passage of such a bill. The number of those who in all prob- 
ability will be committed to an institution of this character is small 
in comparison to the number of insane, and therefore an inebriate 
hospital would not require a large sum of money for its construction 
or maintenance. 

MILK AND BUTTER PRODUCTION AND FARMING: 

Two of the essential articles of diet so necessary in every family 
and institution are milk and butter. There are many products of 
the soil that can be raised in abundance on the farms attached to 



79 

the institutions, and special care and attention should be given 
to this work. By giving a steady cultivation of the soil two 
advantages are gained — purity of food and the benefit it af- 
fords the patient in the employment of mind and body. An ef- 
fort should be made to make the grounds of all these institutions 
model agricultural features of the State. We are frequently met 
by the statement of the officials in charge that "you cannot get 
the inmates to do such and such things, or to do anything and do it 
well." This statement we believe to be true only in part. We know 
there is a large percentage of inmates in every institution that are 
totally incapable o flabor, but we too, know that there are at least 
30 to 60 per cent, of the inmates who can and do if they are given 
the opportunity to produce profitable labor. 

Many of these institutions have excellent stable facilities in 
fact all have. They keep from 70 to 100, and some of them 120 
milch cows. In only one instance have we found an institution that 
had a sufficient quantity of milk produced from their own cows 
the whole year round. If 90 cows, or 120 cows, produce one-half 
to two-thirds of the milk consumed, then double the number of 
cows will supply all the milk that would be necessary, and by the 
proper arrangement of having the new milch cows become produc- 
tive at different seasons, there would be no question but that milk 
in abundance, in quality and quantity would be always in evidence. 
Butter too, is an important ingredient of the food in an institution, 
and during the seasons of the year when an over-supply of milk 
is produced, it should be rendered into butter. We cannot see why 
this should be otherwise and we trust that within the next few 
years this matter will be settled, and in favor of the way we recom- 
mend. 

NURSES AND ATTENDANTS: 

While of course an insane inmate is looked upon as a sick per- 
son, many of them enjoy excellent physical health, and a nurse whose 
time is entirely devoted in these institutions to the care of such per- 
sons has no opportunity for the nursing of the sick, and thereby 
receive such a course as a nurse would in a general hospital. There 
are, however, hospitals or infirmaries attached to these insti- 
tutions, where there is always more or less sickness, which 
require constant attention. A system should be adopted whereby 
these nurses could from time to time take their turn in the 
hospitals, so that they might be educated as much as possible in 
the actual nursing of those afflicted with disease besides being 
insane. In other words, their training must be insufficient, and 
they are not as well qualified to follow their profession as nurses 



80 

trained in a general or regular hospital — for instance, a nurse may 
know the theoretical parts of nursing typhoid fever, pneumonia and 
all contagious and infectious diseases, but she cannot appreciate 
the characteristic of a sudden rise or fall of the pulse and tempera- 
ture if she has never been at the bedside of such patients. Again, 
these institutions do not have the opportunity for the surgical 
course that is so desirable to every nurse. 

The nurses' time and attention should be devoted to their calling 
that is to say, the nursing of the inmates aud it is wrong in prac- 
tice to require either the male or female nurses to do menial work 
such as scrubbing the floors and windows and the hundred other 
things such as willing hands can find to do around an institution. 

Our object in thus treating this subject at such length is the de- 
sire to elevate the standard of the nurse, and in fact if possible, 
to suggest -a method whereby these nurses might, after having 
served a certain course in an institution for the insane, plus a course 
in the Nurses' Training School of a hospital attached to a medical 
school, or a general hospital, could thereby receive a diploma and 
stand on an equal footing with the regular graduate nurses of these 
institutions. 

Again, for instance, if the nurses of these institutions should re- 
ceive a two year course therein and then be admitted into the larger 
and general hospitals, where there are nurses' training schools, such 
as are attached to medical colleges, for instance the University of 
Pennsylvania, the Medico-Chirurgical College and Hospital, Jefferson 
Medical College and many general hospitals, and there learn the prac- 
tical bedside methods of nursing all kinds of diseases that human 
flesh is heir to. for a one years' course, pass their examination and re- 
ceive the institution's diploma, thus having served three years in all. 
It might be that some of the nurses in the general hospitals would 
like to attain a knowledge of nursing the insane and it might be 
beneficial to the institutions to be thus brought into connec- 
tion with the general hospitals and medical schools. These nurses 
could be sent to the various asylums, and there obtain a practical 
knowledge of nursing this unfortunate class of cases. Were such 
a system in vogue if found to be practical the nurses in both insti- 
tutions might be better equipped to follow their profession and on 
graduation could receive a diploma specifying their superior train- 
ing. The length of the course of study can better be prescribed by 
the physician m charge of both classes of institutions. We do not, 
however, wish to criticise the good work of the nurses of these in- 
stitutions. 

We therefore recommend that the Superintendents of the various 
institutions of the 'State should be called to meet in convention 
to consider the views herein expressed. We also recommend that 



81 

there should be a higher and uniform scale of wages paid to such 
employees and much shorter and uniform hours of service be 
adopted in all the institutions, and that the Superintendents should 
be compelled to meet and arrange such a system. We are confident 
that if the welfare of the nurses and attendants is given more con- 
sideration, they will remain longer in the institution and give better 
service. 

As we have said before, we have simply given here our thoughts 
upon this subject in this report, in the hope that better results 
may be obtained so far as the employment of nurses in these in- 
stitutions is concerned regarding the hours employed, the payment 
therefor, service required, and the standard of fitness and ability 
when graduated. 

OVER-CROWDED CONDITIONS: 

As has already been stated and specifically set forth in the state- 
ment of facts regarding each institution, the majority of them are in 
a greatly over-crowded condition. This, to some extent, will be 
remedied when the "New Homeopathic State Hospital for the In 
sane at Allentown" and the Eastern Pennsylvania State Institu- 
tion for Feeble-minded and Epileptics at Spring City are finished. 

As your Honorable bodies are already informed, that a Com- 
mission has been appointed and an appropriation made to start the 
construction of a hospital for the criminal insane at Farview, Wayne 
County, this will also when finished, relieve many of our institu- 
tions of criminal insane inmates as well as take under care and 
treatment many who are incarcerated in the jails and peniten- 
tiaries. 

PER CAPITA COST OF MAINTENANCE: 

The per capita cost of maintenance is different in each institution, 
and varies from $2.99-| a week at Wernersville to $4.36 a week 
at Dixmont although they receive the same amount for the pay 
of inmates namely, $3.75 per week. This per capita cost pays for 
the food, clothing, attendants, nurses, coal and everything sup- 
plied to the institution for its maintenance. The replacing of new 
furniture for old and worn-out furniture is paid for out of the per 
capita cost. Besides this the item of repairs is also paid therefrom. 
We believe that particular attention should be paid by the State 
to this feature in all institutions. The moneys paid for repairs 
should be itemized and specifically set forth by the authorities, and 

6 



82 

no repairs should be permitted to be made that were not absolutely 
essential. As we have suggested blanks should be furnished the 
institutions for this purpose, and such work as painting, glazing, 
the building of fences, repairing of roads and the like, should 
be minutely set forth in items, so that it may be known to those in 
authority exactly where the money goes, and that it has been spent 
judicially and properly. And until this is required in the strictest 
and minutest sense it will be difficult to know where economy can 
be introduced on this item. 

SEPARATE CARE OF EPILEPTICS: 

It is universally conceded by the heads of all the public insti- 
tutions, by philanthropists and charity workers in general, as well 
as all private practitioners of medicine, that epilepsy or what is 
commonly known as "fits," is the most painfully distressing and 
dangerous as far as life is concerned, in hazardous places, known to 
the profession of medicine and with which they have to deal. For 
over twenty years the Board of Public Charities in this State has, in 
its annual report, recommended the separate or colony treatment for 
those unfortunately afflicted with this disorder. In view of this fact 
your Commission has made a thorough, complete and exhaustive ex- 
amination into every detail, in as far as we could, pertaining to this 
disease and the best methods of its custodial care. We find that 
most all of the progressive states of the Union, as well as all the 
countries of Europe have adopted the special care, or what is known 
among specialists as the "Colony" care for epileptics. This means 
the erection of suitable buildings, surrounded by an extensive acre- 
age, say two to three acres to the inmate, where they can be given 
employment most suited to their condition and where specially train- 
ed physicians should treat them in accordance with the most recent 
scientific means and methods. The new State institution now being 
erected at Spring City, Chester County, this State, will supply, in 
part what has long been needed, but as this is to be a compound 
institution, that is, the feeble-minded as well as the epileptic will 
be treated therein, it cannot truthfully be said to be an institution 
for epileptics. Your Commission would recommend, therefore, that 
a colony institution be established in this State at the earliest 
date feasible, and that it be located as centrally as possible, 
where land can be procured at a reasonable figure and where sep- 
arated from the dangers and annoyances incident to crowded cen- 
ters, the epileptics alone can be cared for in a manner suitable for 
such a grave and serious malady. 

The feeble-minded should not be treated under the same roof with 
the epileptics. 



83 
SUPERINTENDENTS : 

To start with the Superintendent should be a man of studious 
habits. He should be fundamentally learned in the department in 
which he is interested, namely, in the diseases of the mind and ner- 
vous system. We do not propose to say that the Superintendents 
are not learned, but we do say and say with emphasis, that many 
of them do not keep apace with modern practice and experience 
along the line of neurological thought. 

As the purpose of this Commission is to do the greatest amount 
of good to the greatest number of afflicted we propose 
to make our report plain, concise and comprehensive upon 
this subject. We found no two institutions that we examined alike 
in care and treatment. Therefore, it must be conclusive 
that the highest standard of excellence has not been reached and 
maintained by all. The Superintendent and physician, living in the 
institution as they do from day to day, mingling as they are sup- 
posed to with the inmates, to a great extent, become indifferent in 
the exercise of the highest medical skill in the treatment of their 
patients. To a great extent, this does not seem unnatural. The 
inmates are treated more as a class and not as individual cases. 
The treatment and attention becomes routine and not special, which 
we believe is the treatment necessary for the welfare of these un- 
fortunates. Each and every inmate should receive a thorough 
physical and mental examination from time to time, and his or her 
condition put down in writing, so that the progress of the disease 
can be more accurately watched and studied. This would serve 
to eliminate the similiarity of treatment. A person admitted into 
an insane asylum does not necessarily mean that he or she is in 
need of a prescribed routine treatment. Insanity is a disease of the 
mind, for which there is always a cause and the causes of insanity 
are many hence, the same treatment for all cannot be prescribed. 
For this reason we believe and recommend that the Superintendent, 
with his staff of physicians, should at stated times be in conference 
with members of the faculty of the various medical schools of the 
State, to consult with each other and decide on plans of treatment 
to be followed with each of the inmates. The association of these 
physicians with the highest medical skill, such as we find in our 
medical colleges would result in our judgment most beneficially 
to the Superintendent and his staff, as each medical college, not 
only in this State but in the country have a special chair of in- 
struction on neurology and psychology. 

For instance, the Governor of the State could appoint from the 
faculty of the various medical schools consultant physicians on the 
staff of doctors connected with the institutions. We recommend 



84 

that the Superintendents should meet and take up this feature as 
suggested. We make this recommendation on the ground that it 
might prove beneficial to the suffering humanity under their care. 
These Superintendents are simply the employees of the State, al- 
though selected by the various boards of trustees. They should 
not feel that they possess all the wisdom and knowledge necessary 
to administer to the wants of their wards, and the doors of these 
institutions cannot be thrown open too wide as an invitation to the 
highest medical skill of the State to enter. 

These institutions should also be equipped with the latest and 
best electrical apparatus, such as the galvanic, static and Faradic 
and high-frequency current, and all other modern appliances that 
are used by our medical schools in administering to the wants of 
the sick. None of these did we find in any of our institutions. 

In the testimony and in our comments regarding each individual 
institution we state the amount of the salary received by the Super- 
intendents. We are of the opinion that a physician to become the 
Superintendent of such an institution, and who possesses the medi- 
cal skill, science and executive ability, and has under his control a 
thousand inmates, as the minimum, should receive not less than five 
thousand dollars ($5,000) per annum. 

TREATMENT OF INSANE AND IMBECILES: 

As is thoroughly understood and acknowledged by the best au- 
thority on diseases of the mind and nervous system, neurologists of 
national and international reputation, that no kind of treatment, no 
matter how otherwise materially efficient it may be, can be properly 
put into use in faultily constructed and illy arranged institution 
buildings. And in like manner, no buildings, no matter how san- 
itary or modernly constructed, nor up-to-date in all their appoint- 
ments, may be, unless the management and the remedies 
used, both medicinal, therapeutical and custodial can be effective 
unless properly carried into execution along the most approved lines. 
Your Commission, then, in order that the very best results may be 
obtainable, have given particularly special attention to the manage- 
ment and treatment of these unfortunate mentally afflicted and in 
their examination of these different celebrated specialists in the 
treatment of insanity, have gained from them, and here recommend, 
a variety of special and commendable features in the treatment 
of the insane which is in use in all of the best institutions both in 
the United States and in Europe. The first and greatest object 
sought for in every institution is to effect the greatest number of 
cures feasible and where cures cannot be effected, to produce as 
much improvement as is within the reach of the science and art 



85 

i 
of medicine to effect. In our recommendations then, we pay partic- 
ular and emphatic stress upon the following lines of treatment and 
recommend their adoption in every institution in the State where 
the insane are housed and cared for. 

As we have said in other parts of our report, the buildings for the' 
housing of the insane should be thoroughly modern and exactingly 
constructed with the view of giving the inmates the best ventilation, 
light and general sanitary effect that it is possible to produce within 
the walls of any building. The cottages should be (and we use the 
word "cottages'' in counter-distinction to buildings as these appear to 
be favored expressions with alienists throughout the country) heated 
and the heating should be carefully looked after and kept at an 
even and equitable temperature at all times of the day and night. 
They should comport as near as possible with the temperature of 
the human body, or with the temperature most in accord with the 
inmates of that particular cottage or room in which they will be 
located. Part of the time to have the room too hot and part of 
the time too cold, and a portion of the time at an even temperature 
cannot but result in detriment to the physically and mentally en- 
feebled. This is a matter which should receive the careful atten- 
tion of the Superintendent and his assistants, and to carry this 
recommendation out to a thorough nicety, an exactly gauged heat 
thermometer should be placed in every room in the buildings and 
should be frequently consulted by the attendant in charge to 
see that the temperature is even and correct. The attendants should 
receive instructions at what temperature to keep the room or rooms 
over which they have guardianship and should receive this instruc- 
tion only from the medical Superintendent or one of his most com- 
petent assistants. 

The proper handling of the ventilators wherever they have been 
installed should be carefully taught and impressed upon the minds 
of the nurses and attendants. Where these cannot be found, and 
we regret to say that such is a fact in many of the institutions, ven- 
tilation must be obtained through windows and these should be 
opened at the bottom and the top. at different periods during the 
day as well as night, but care should be taken that when this is 
done the patients should not be permitted to occupy such a position 
where they come in contact with a draught and injure their physical 
condition. 

We might say in one institution we visited while in one of their 
most modern buildings which was equipped with ventilators over 
each window they were all closed and the odor in the room was very 
bad. The superintendent to several members of your Commission 
said, "Of course the odor here is caused by the neglect of the nurses 



86 

in the proper handling of these ventilators." It was then suggested 
to him that rules stringent in character should be adopted by him- 
self and the Board of Trustees and enforced regarding this import- 
ant feature. 

The clothing of the inmates should receive as much attention 
from the medical authorities of the institution as the heating, light- 
ing and ventilation. The body should be clotheed in the most careful 
manner and in this we mean in weight and texture. It should be 
neither too light nor too heavy, nor cumbersome to wear. It should 
be tidy in appearance, well fitting and adjusted to the body in a way 
that keeps an equitable temperature to all parts of the individual's 
anatomy. 

The inmates should be dressed in as homelike and modest a garb 
as is possible to furnish with the means supplied by the State. 
They should be supplied with collars and neckties only where the 
same can be worn and by thus furnishing these little accessories it 
will help to teach them to be cleanly in appearance and thus improve 
their condition and their general health. This would only serve as 
one feature mentioned with the many others herein specifically 
named to add to the comfort and welfare of the inmates. 

The hours of exercise should be carefully and advisedly chosen, 
that is the inmates should take walks and exercises in the open 
during the hours of sunshine, excepting during the seasons of ex- 
treme heat when they should always be kept in the shade when out 
of doors. Not a day should be allowed to pass without every inmate, 
physically able taking a stated amount of exercise a certain num- 
ber of miles should be walked certain definite exercises should be 
gone through in a well and carefully equipped gymnasium particu- 
larly suitable for the treatment of the insane. Any patient showing 
undue fatigue after these exercises should undergo a careful physi- 
cal examination by one of the medical staff, and all things pertain- 
ing to breathing, heart action, and muscular fatigue should be noted. 
This may appear like imposing a great deal and some of it unneces- 
sary 'abor upon the physicians in charge, but as it is for the trans- 
fer Ion of just such duties that such physicians are employed, it is 
uoi l^'j much to exact the faithful performance thereof. 

Patients should, under no circumstances (and we speak of those 
physically able) be permitted to lounge around the grounds or corri- 
dors, or sleep under trees, or wherever they find it convenient nor 
should they be permitted to wander aimlessly through the corridors 
or grounds, as not a moment of their waking time should they be 
allowed in idleness. 

That something should always be supplied wherever possible to 
mildly attract their attention and keep their minds pleasantly 



87 

occupied should be the rule of every institution. Their heads should 
be carefully looked after their hair kept trimmed and their scalp 
clean and free from all deposits remotely approaching filth in any 
way. They should be taught the lessons of neatness and should, 
under no circumstances, be allowed to relapse into indifference 
which they do and which was so sadly in evidence in a great majority 
of the institutions which we visited. 

Their eyes, too, should be carefully looked after as it is a well 
known fact, and one upon which particular stress is laid by the best 
neurologists, that eye strain and visual irregularities are among the 
most exciting and patent causes of mental derangement, and while 
it does not actually cause these diseases, it is an important factor in 
adding to their severity and often stands between their final re- 
covery or material improvement. 

The question of hydro-therapy, or the treatment of heat or cold, 
either by water or dry heat and cold, is conceded to be among the 
best means of treating insanity in its every form. We therefore 
most urgently recommend that the authorities of the different State 
institutions install as soon as possible hydro-therapeutic systems of 
the most approved modern and scientific construction. These, in 
conjunction with the shower, turkish and electric bath systems, 
including the swimming pools, should be constructed and installed 
under the supervision of the best medical experts obtainable. No 
matter how proficient mechanical engineers and architects may be 
in the planning and constructing of these essential medical auxili- 
aries, they cannot of necessity possess the same technical knowledge 
of their practical use, that an educated physician possesses, and we 
therefore most heartily recommend that when these systems are 
being put in place and prepared for use, that they not alone be 
arranged under the supervision of the medical superintendent, but 
that the best medical experts on this special subject be consulted 
and inspect the work from time to time and thus see that it is being 
placed in order according to the best and most scientific methods. 
There is no place that an exacting scrupulously accurate and scien- 
tific knowledge is so incumbent as where it pertains to a knowledge 
of therapeutical equipment of this nature. Thousands of dollars 
may be spent in the construction and arrangement of these different 
medical auxiliaries, but unless they are placed in order with a view 
single to their usefulness and efficiency in application, every dollar 
of it is uselessly spant and no good will accrue from its being in the 
institution. 

The attendants and nurses, and by these we mean those who are 
hourly in attendance, should possess a mind particularly trained and 
moulded for that kind of delicate service whenever they can be had. 



88 

We believe that the greatest affliction that can befall mankind is the 
deprivation of his mind and the care and attention extended to 
such should be the most kindly and delicate. This qualification can- 
not come to an individual by teaching or training alone. It should 
be an inherent principle in their economy. They should have a mind 
equipped and regulated single to the good and general betterment 
of the wards assigned to their care. They should be kind, gentle and 
patient in their attention and should never for a moment, even under 
the greatest provocation, lose sight of the fact that they are dealing 
with human beings deprived of their power of reasoning or ability 
to differentiate between right and wrong. The attendant must not 
only act for himself, but he must act for his patient, as it is his 
normal mind that guides them both. For this purpose we recom- 
mend that each public institution endeavor to have always in train- 
ing a class of nurses and attendants and that they receive their 
instructions from the medical authorities, and as we have already 
herein suggested, in the institutions where their work is to be per- 
formed and nurses' training schools attached to medical schools and 
many general hospitals. 



WATER SUPPLY AND SEWAGE. 

We recommend that the State Board of Health should carefully 
inspect all of the State institutions so far as the water supply is 
concerned, and also to inspect and examine the system and 
the method of disposing of sewage, and that the said Board 
should be given authority and power to require to be made any 
changes, either by the improvement of the systems already in- 
augurated or the construction of new ones, which, in their judg- 
ment, they may deem best. 

And in the consideration of this question we specially refer to a 
letter of Samuel G-. Dixon, the State Commissioner of Health, in 
which he emphasizes the importance of having the direction and 
control of the operation of the sewage and water plants of all the 
institutions "and whenever necessary to enlarge any plant or to 
repair the same or renew therefor;" again, "that the State Treas- 
urers shall set aside a requisite amount to be named by the Com- 
missioner of Health to defray the cost of such work to be done by 
the Board of Trustees and the approval of the Commission." 

This constitutes the report of our labors, which, while they have 
been exacting have been most interesting, and we have endeavored 
to set forth fairly and tersely what we have seen and heard, together 
with our conclusions and recommendations, and if our work shall 



89 

result in benefiting those who are so sorely afflicted even in the 
slightest degree, we will feel that it has not been in vain. 

Respectfully submitted, 

HENRY S. WALTON, Chairman. 
W. P. SNYDER, 
CYRUS E. WOODS, 
WILTON HEIDELBAUGH. 
JNO. S. FISHER, 
R. B. SCOTT, 
JAS. F. WOODWARD, 
E. E. BEIDLEMAN. 



90 



PENNSYLVANIA STATE LUNATIC HOSPITAL, 



HARRISBURG. 



The weekly bill of fare of this Institution is as follows: 

ATTENDANTS. 
SUNDAY: 

Breakfast — Oat meal and milk, eggs or pudding, bread, butter, 

coffee. 
Dinner — Pork, baked beans, potatoes, red beets, bread, butter. 
Supper — Bread, butter, potatoes, pig's foot jelly, ginger cakes, 

coffee, tea. 

MONDAY: 

Breakfast — Oat meal and milk, meat stew or scrapple, bread, 

butter, coffee. 
Dinner — Ham, two vegetables, bread, butter. 
Supper — Bread, butter, potatoes, cold pudding, coffee, tea. 

TUESDAY: 

Breakfast — Oat meal and milk, salt mackerel or beef stew, bread, 

butter, coffee. 
Dinner — Roast beef, two vegetables, bread, butter. 
Supper — Bread, butter, cold beef, potatoes, coffee, tea. 

WEDNESDAY: 

Breakfast — Oat meal and milk, beef stew and brown gravy, bread, 

butter, coffee. 
Dinner — Boiled beef, soup, potatoes, bread, butter 
Supper — Bread, butter, cold beef, potatoes, ginger cakes, coffee, 

tea. 

THURSDAY: 

Breakfast — Oat meal and milk, corn beef or sausage, bread, butter, 
coffee. 



91 

Dinner — Roast beef and vegetables, or sausage for patients, roast 
pork for attendants, sauer kraut, potatoes, apple sauce, bread, 
butter. 

Supper — Bread, butter, cold pork, potatoes, rolls, coffee, tea. 

FRIDAY: 

Breakfast — Oat meal and milk, beef steak and brown gravy, bread, 

butter, coffee. 
Dinner — Fresh fish, two vegetables, bread, butter. 
Supper — Bread, butter, potatoes, cold veal, prunes, coffee, tea. 

SATURDAY: 

Breakfast — Oat meal and milk, beefsteak and brown gravy, bread, 

butter, coffee. 
Dinner — Boiled beef, rice soup, potatoes, bread, butter. 
Supper — Bread, butter, cold beef, potatoes, coffee, tea. 

PATIENTS. 
SUNDAY: 

Breakfast — Oat meal and milk, eggs or pudding, meat, bread, 

butter, coffee. 
Dinner — Pork, baked beans, potatoes, red beets, bread, butter. 
Supper — Bread, butter, ginger cakes, tea. 

MONDAY: 

Breakfast — Oat meal and milk, scrapple, bread, butter, coffee. 
Dinner — Ham, two vegetables, bread, butter. 
Supper — Bread, butter, tea. 

TUESDAY: 

Breakfast — Oat meal and milk, bread, butter, coffee. 
Dinner — Roast beef, two vegetables, bread, butter. 
Supper — Bread, butter, tea. 

WEDNESDAY: 

Breakfast — Oat meal and milk, bread, butter, coffee. 
Dinner — Boiled beef, soup, potatoes, bread, butter. 
Supper — Bread, butter, ginger cakes, tea, 

THURSDAY: 

Breakfast — Oat meal and milk, bread, butter, coffee. 
Dinner — Roast beef and vegetables, or sausage for patients, pork 
for attendants, sauer kraut, potatoes, apple sauce, bread, butter 
Supper — Bread, butter, rolls, tea. 



92 

FRIDAY: 

Breakfast — Oat meal and milk, bread, butter, coffee. 
Dinner — Fresh fish, two vegetables, bread, butter. 
Supper — Bread, butter, prunes, tea. 

SATURDAY: 

Breakfast — Oat meal and milk, bread, butter, coffee. 

Dinner — Boiled beef, rice soup, potatoes, bread, butter. 

Supper — Bread, butter, tea. Potatoes for working men. 

Vegetables and fruit vary with the season. Syrup is served morn- 
ing and evening. 

On Thanksgiving Day and Christmas, turkeys and cranberry sauce 
are supplied; oysters on New Year's Day, and ice cream for one 
hundred patients is made about once in two or three weeks. 

Vegetables, grown in the hospital garden, are furnished in their 
season, as also melons, grapes, and small fruit. 

Special diet consists of toast, soup, beef tea, chicken broth, eggs, 
milk from our cows, egg nogs, rice, baked and boiled custard, corn 
starch, chocolate, chicken and beefsteak, etc., as required. 

Relishes and sauces are added to give variety to the meals. The 
working men have a lunch in the forenoon, fried potatoes and cold 
meat for supper. Work in the wards is rewarded by lunch. 



93 



STATE HOSPITAL FOR THE INSANE. 



NORRISTOWN. 



The weekly bill of fare of this Institution is as follows: 

ATTENDANTS. 
SUNDAY: 

Breakfast — Cereal, Hamburg steak, fried potatoes, bread, butter, 

Dutch cake. 
Dinner — Soup, roast beef, potatoes, corn or peas, bread, coffee. 
Supper — Gold meat, fried potatoes, bread, butter, stewed fruit, tea 

or coffee. 

MONDAY: 

Breakfast — Cereal, steak or scrapple, fried potatoes, bread, 

butter, coffee. 
Dinner — Soup, roast beef, potatoes or beans, corn, bread, coffee, 

occasionally pudding. 
Supper — Fresh fish, fried potatoes, bread, butter, tea or coffee, 

stewed fruit. 

TUESDAY: 

Breakfast — Cereal, chops, steak or scrapple, fried potatoes, bread, 

butter, coffee. , 

Dinner — Soup, roast mutton, potatoes, rice, bread, coffee. 
'Stopper — ^Mutton stew, fried potatoes, bread, butter, tea, coffee, 

stewed fruit, cheese. 

WEDNESDAY: 

Breakfast — Cereal, ham and eggs, fried potatoes, bread, butter, 

coffee. 
Dinner — Soup, meat and vegetables, boiled beef, potatoes, peas, 

pickles, bread, coffee. 
Supper — Fresh fish, fried potatoes, bread, butter, tea or coffee, 

stewed fruit. 



94 
THURSDAY: 

Breakfast — Cereal, Hamburg steak, fried potatoes, bread, butter, 

coffee. 
Dinner — Soup, corn beef, chicken or veal pot pie, potatoes, beans 

or corn, cabbage or tomatoes, bread, coffee. 
Supper — Fried liver, potatoes, bread, butter, warm biscuit, tea or 

coffee, stewed fruit. 

FRIDAY: 

Breakfast — Cereal, fish and steak, fried potatoes, bread, butter, 

coffee. 
Dinner — Soup, baked fresh fish, roast beef, potatoes, tomatoes, 

Peas or corn, bread, coffee, bananas or apples. , 

Supper — Cold meat, potatoes, bread, butter, warm biscuit, cheese, 

tea or coffee, stewed fruit. 

SATURDAY: 

Breakfast — Cereal, steak, chops or scrapple, fried potatoes, bread, 

butter, coffee. 
Dinner — Soup, roast beef, potatoes, hominy, tomatoes or peas, 

bread, coffee. 
Supper — Oold meat, potatoes, bread, butter, tea or coffee, ginger 

bread, canned peaches. 

PATIENTS. 
SUNDAY: 

Breakfast — Cereal, Hamburg steak, bread, butter, molasses, coffee. 
Dinner — Roast beef, potatoes, tomatoes or cabbage, bread, ba- 
nanas. 
Supper — Bread, butter, stewed fruit, tea. 

MONDAY: 

Breakfast — Cereal, bread, butter, coffee. 

Dinner — Boiled beef, potatoes, beans or other vegetables, bread, 

fruit occasionally. 
Supper — Bread, butter, stewed fruit, tea, scrapple in season. 

TUESDAY: 

Breakfast — Hash with potatoes, bread, butter, coffee. 

Dinner — Vegetable soup, potatoes, rice, bread, fruit and pudding. 

Supper— Bread butter, stewed fruit, tea, cheese. 



95 

WEDNESDAY: 

Breakfast — Cereal, bread, butter, molasses, coffee. 

Dinner — Meat and vegetables, stew, peas, potatoes, pickles, bread, 

fruit or pudding. 
Supper — Bread, butter, stewed fruit, tea. 

THURSDAY: 

Breakfast — Cereal, Hamburg steak, bread, butter, coffee. 
Dinner — Corned beef, potatoes, cabbage or beans, bread, occasion- 
ally pudding. 
Supper — Bread, butter, warm biscuit, stewed fruit, tea. 

FRIDAY: 

Breakfast — Cereal, bread, butter, molasses, coffee, fish, salt. 
Dinner — Fresh fish, baked or fried, potatoes, tomatoes, bread, fruit, 

usually bananas. 
Supper — Bread, butter, cheese, ginger bread, tea, stewed fruit. 

SATURDAY: 

Breakfast — Hash with potatoes, bread, butter, coffee. 

Dinner — Soup, potatoes, hominy, bread, dessert, usually pudding. 

Supper — Bread, butter, tea, ginger bread. 

During berry season fresh berries are substituted for stewed fruit. 

From October to April, sausage and scrapple furnished once a 
week. 

Fresh tomatoes, corn, beans, beets, spinach, sweet potatoes, onions, 
and other fresh vegetables furnished in season. 

Stewed fruit is varied and consists of prunes, peaches, pears, 
apples, apricots, nectarines, etc. , 

The sick and special diet is furnished on orders given by the 
doctors and may consist of one or more of the following articles: 
soup, oysters, steak, chops, chicken, ham, eggs (raw and cooked), 
toast and farina, tapioca, and rice pudding; also bananas, oranges, 
lemons, apples, etc. 

At the outings in the picnic woods, during the summer, the 
patients are supplied with ice cream, lemonade, sandwiches, cheese, 
cakes and bananas. 

On Thanksgiving and Christmas days all get turkey, cranberry 
sauce, white and sweet potatoes, corn, cold slaw, celery, mince pies, 
oranges, apples, bananas. Candy on Christmas, 



96 



STATE HOSPITAL FOR THE CHRONIC INSANE. 



WERNERSVILLE. 



The weekly bill of fare of this Institution is as follows: 

ATTENDANTS. 
MONDAY: 

Breakfast — Pork chops, fried potatoes, oat meal, bread, butter, 

coffee. 
Dinner — Roast pork, mashed potatoes, sauer kraut, beans, bread, 

butter, coffee, bread pudding. 
Supper — Gold beef, potatoes, radishes, stewed peaches, bread, 

butter, coffee, tea. 

TUESDAY: 

Breakfast — Mutton chops, fried potatoes, oat meal, bread, butter, 

coffee. 
Dinner — Noodle soup, roast mutton, potatoes, lima beans, celery, 

bread, butter, coffee, ice cream. 
Supper — Liver pudding, cold beef, potatoes, corned beef, rusks, 

bread, butter, coffee, tea. 

WEDNESDAY: 

Breakfast — Beef steak, fried potatoes, oat meal, bread, butter, 
coffee. 

Dinner — Vegetable soup, roast beef, potatoes, stewed corn, par- 
snips, bread, butter, coffee. 

Supper — Cold beef, potatoes, mush and milk, bread, butter, coffee, 
tea, cake. 

THURSDAY: 

Breakfast — Beefsteak, fried potatoes, oat meal, bread, butter, 

coffee. 
Dinner — Roast beef, potatoes, sweet potatoes, stewed onions, peas, 

bread, butter. 
Supper — Cold beef, tripe, potatoes, cheese and crackers, biscuits, 

radishes, bread, butter, coffee, tea. 



97 
FRIDAY: 

Breakfast — Fried liver, fish, fried potatoes, oat meal, bread, butter, 

coffee. 
Dinner — Spare-ribs, potatoes, stewed tomatoes, beans, bread, 

butter, coffee, tapioca pudding. 
Supper — Cold beef, pigs' feet, potatoes, corn bread, stewed 

peaches, bread, butter, coffee, tea. 

SATURDAY: 

Breakfast — Fried sausage, fried potatoes, oat meal, bread, butter, 

coffee. 
Dinner — Vegetable soup, roast beef, potatoes, macaroni, lima 

beans, bread, butter. 
Supper — Cold beef, potatoes, stewed prunes, pickles, bread, butter, 

coffee, tea. 

SUNDAY: 

Breakfast — Pork chops, fried potatoes, oat meal, bread, butter, 

coffee. 
Dinner — Roast beef, potatoes, stewed corn, stewed tomatoes, 

bread, butter, coffee. 
Supper — Cold beef, potatoes, ginger bread, apple butter, bread, 
coffee, tea. 

PATIENTS. 
MONDAY: 

Breakfast — Mutton and stewed potatoes, oat meal, bread, butter, 

coffee. 
Dinner — Pork, potatoes, sauer kraut, bread. 
'Supper — Stewed peaches, radishes, bread, butter, tea. 

TUESDAY: 

Breakfast — Beefsteak and stewed potatoes, bread, butter, coffee. 
Dinner — Roast beef, potatoes, beans, celery, bread, corn starch 

pudding. 
Supper — Corn bread, stewed prunes, bread, butter, tea. 

WEDNESDAY: 

Breakfast — Corned beef, stewed potatoes, bread, butter, coffee. 
Dinner — Soup, boiled beef, potatoes, stewed onions, bread. 
Supper — Mush and milk, bread, butter, tea. 



98 

THURSDAY: 

Breakfast — Beef and stewed potatoes, bread, coffee. 

Dinner — Corned beef, potatoes, stewed onions, parsnips, bread. 

Supper — Cheese and crackers, radishes, bread, butter, tea. 

FRIDAY: 

Breakfast — Corned beef and stewed potatoes, bread, butter, coffee. 
Dinner — Fish, potatoes, carrots, bread, tapioca pudding. 
Supper — Corn bread, stewed peaches, bread, butter, tea. 

SATURDAY: 

Breakfast — Beef and stewed potatoes, coffee. 

Dinner — Rice soup, boiled beef, potatoes, macaroni, bread, pie. 

Supper — Stewed prunes, pickles, bread, butter, tea. 

SUNDAY: 

Breakfast — Veal or beef and stewed potatoes, bread, butter, coffee. 

Dinner — Corned beef, potatoes, stewed tomatoes, bread. 

Supper — Ginger bread, apple' butter, bread, butter, tea, straw- 
berries, melons, grapes, and the various other fruits are fur- 
nished in season. 



99 



STATE HOSPITAL FOR THE INSANE. 



DANVILLE. 



The weekly bill of fare of this Institution is as follows: 

SUNDAY: 

Breakfast — Beefsteak, gravy, bread, butter, coffee. 

Dinner — Roast beef, gravy, sweet potatoes, soup, beans, butter, 

apples, bread. 
Supper — Bread, butter, cinnamon buns, syrup, tea, 

MONDAY: 

Breakfast — Fried ham, bread, butter, coffee. 

Dinner — Boiled beef, potatoes, vegetables, soup, bread, apples. 

Supper — Bread, butter, syrup, tea. 

TUESDAY: 

Breakfast — Boiled mackerel, bread, butter, coffee. 
Dinner — Boiled pork, potatoes, sauer kraut, bread, apples. 
Supper — Bread, butter, stewed peaches, ginger-snaps, tea. 

WEDNESDAY: 

Breakfast — Beefsteak, gravy, bread, butter, coffee. 
Dinner — Roast beef, gravy, potatoes, turnips, bread, apples. 
Supper — Bread, butter, syrup, tea. 

THURSDAY: 

Breakfast— Fried sausage, bread, butter, coffee. 
Dinner — Roast beef, gravy, potatoes, slaw, bread. 
Supper — Bread, butter, syrup, tea. 

FRIDAY: 

Breakfast — Fresh fried fish, bread, butter, coffee. 

Dinner — Roast beef, gravy, potatoes, rice, cucumber, pickles, 

bread, apples. 
Supper — Bread, butter, syrup, tea. I 



100 

SATURDAY: 

Breakfast — Beefsteak, gravy, soda biscuits, bread, coffee. 
Dinner — Corned beef, potatoes, boiled cabbage, bread, apples. 
Supper — Bread, butter, stewed peaches or prunes, tea. 



101 



STATE HOSPITAL FOR THE INSANE. 



WARREN. 



The weekly bill of fare of this Institution is as follows: 



ATTENDANTS. 

December, 1906. 



SUNDAY: 



Breakfast — Oat meal, milk, fried ham, bread, butter, syrup, coffee. 
Dinner — Gold ham, potatoes, pickled beets, bread, butter, syrup, 

bread pudding and milk. 
Supper — Cold meat, baked potatoes, bread, butter, syrup, pica- 

lilli, apple sauce, ginger bread, tea, and milk. 

MONDAY: 

Breakfast — Oat meal, milk, boiled eggs, bread, butter, syrup and 

coffee. 
Dinner — Roast beef, gravy, potatoes, cabbage, bread, butter, syrup, 

rice and milk. 
Supper — Cold beef, fried potatoes, bread, butter, syrup, peaches, 

milk and tea. 

TUESDAY: 

Breakfast — Oat meal, milk, steak, gravy, bread, butter, syrup and 

coffee. 
Dinner — Roast beef, gravy, vegetable soup, potatoes, tomatoes, 

bread, butter, syrup, apple pie, and milk. 
Supper — Cold beef, fried potatoes, bread, butter, syrup, stewed 

grapes, milk and tea. 

WEDNESDAY: 

Breakfast — Oat meal, milk, fried ham, bread, stew butter, syrup, 

and coffee. 
Dinner — Roast pork, gravy, potatoes, peas, bread, butter, rice and 

syrup. 
Supper — Cold pork, fried potatoes, bread, butter, syrup, prunes, 

tea and milk. 



102 

THURSDAY: 

Breakfast — Steak, gravy, bread, butter, syrup, milk and coffee. 
Dinner — Boast beef, gravy, potatoes, creamed cabbage, bread, 

butter, syrup, corn starch and milk. 
Supper — Cold beef, fried potatoes, bread, butter, syrup, prunes, 

tea and milk. 

FRIDAY: 

Breakfast — Oat meal, milk, fried fish, bread, butter, syrup and 

coffee. 
Dinner — Roast lamb, gravy, baked beans, catsup, creamed onions, 

bread, butter, syrup, apple sauce, and milk. 
Supper — Cornmeal mush, cold lamb, baked potatoes, bread, butter, 

syrup, apple sauce, tea and milk. 

SATURDAY: 

Breakfast — Oat meal, milk, steak, gravy, bread, butter, syrup and 

coffee. 
Dinner — Roast lamb, gravy, potatoes, mashed turnips, bread, 

butter, syrup, tapioca and milk. 
'Supper — Cold lamb, fried potatoes, bread, butter, syrup, peaches, 

tea and milk. 

CHRISTMAS DINNER. 

Turkey and cranberry sauce, roast pig, mashed potatoes, cold slaw, 
bread, butter, syrup, mince pie and milk. 

PATIENTS. 

December 1906. 
SUNDAY: 

Breakfast — Oat meal, milk, sausage, bread, butter, syrup and 

coffee. 
Dinner — Cold ham, potatoes, tomatoes, pickled beets, bread, syrup, 

bread pudding and milk. 
Supper — Oat meal, milk, bread, butter, syrup and tea. 

MONDAY: 

Breakfast — Oat meal, milk, scrapple, bread, butter, syrup and 

coffee. 
Dinner — Roast beef, gravy, potatoes, cabbage, bread, syrup, rice 

and milk. 
Supper — Oat meal, milk, bread, butter, syrup and tea. 



103 
TUESDAY: 

Breakfast — Oat meal, milk, steak, gravy, bread, butter, syrup and 

coffee. 
Dinner — Boiled beef, vegetable soup, potatoes, bread, butter, 

syrup, apple pie and milk. 
Supper — Oat meal, milk, bread, butter syrup and tea. 

WEDNESDAY: 

Breakfast — Oat meal, milk, meat adn potato stew, bread, butter, 

syrup, coffee. 
Dinner— Roast pork, gravy, potatoes, carrots, bread, syrup, corn 

starch, custard and milk. 
Supper — Oat meal, milk, bread, butter, syrup and tea. 

THURSDAY: 

Breakfast — Oat meal, milk, steak ,gravy, bread, butter, syrup and 

coffee. 
Dinner — 'Stewed beef, gravy, potatoes, creamed cabbage, rice, 

syrup and milk. 
Supper— Oat meal, milk, bread, butter, syrup and tea. 

FRIDAY: 

Breakfast — Oatmeal,, milk, fried fish, bread, butter, syrup, and 

coffee. 
Dinner — Baked beans, potatoes, creamed onions, bread, butter, 

syrup, apple sauce and milk. 
Supper — Cornmeal mush, milk, bread, butter, syrup and tea. 

SATURDAY: 

Breakfast — Oat meal, milk, steak, gravy, bread, butter, syrup and 

coffee. 
Dinner — Roast lamb, gravy, potatoes, mashed turnips, bread, syrup, 

rice and milk. 
Supper — Oat meal, milk, bread, butter, syrup and tea. 
Working men always receive cold meat for supper. 

CHRISTMAS DINNER. 

Turkey, roast pig, mashed potatoes, cranberries, cold slaw, bread, 
butter, syrup, mince pie and milk. 



104 



STATE INSTITUTION FOR FEEBLE-MINDED 
OF WESTERN PENNSYLVANIA. 



POLK. 



This Institution has no set bill of fare. A sample of the weekly 
menu is as follows : 

ATTENDANTS. 
SUNDAY: 

Breakfast — Rolled oats, milk, bread, butter, tea, coffee, befsteak, 

fried potatoes, toast. 
Dinner — Roast veal, gravy, bread, butter, tea, coffee, browned 

potatoes, June peas, stewed tomatoes, cold slaw, apple pie, 

cheese, jelly. 
Supper — Cold sliced ham, escalloped potatoes, stuffed peppers, 

bread, butter, preserved peaches, tea, coffee, cake, oranges. 

MONDAY: 

Breakfast — Force, milk, bread, butter, coffee, toast, loin pork, 

hashed broad potatoes. 
Dinner — Boiled corned beef, lima beans, steamed potatoes, mashed 

turnips, bread and butter pudding, bread, butter, tea, coffee. 
Supper — Roast ribs of beef, gravy, macaroni and cheese, potatoes 

in jackets, mustard mickles, crullers, bananas, bread, butter, 

tea, coffee. 

TUESDAY: 

Breakfast — Puffed rice, milk, bread, butter, coffee, toast, fried 

pork, mashed potatoes. 
Dinner — Boiled beef, bread, butter, tea, coffee, mashed potatoes, 

buttered beets, creamed corn, rice pudding with raisins. 
Supper — Cold beef, bread, butter, tea, coffee, potato cakes, Chili 

sauce, stewed apricots, ginger cakes, apples. 

WEDNESDAY: 

Breakfast — Rolled oats, milk, bread, butter, tea, coffee, pork, buck- 
wheat cakes, syrup. * 



105 

Dinner — Navy bean soup, hot crackers, roast mutton, browned 
potatoes, mashed turnips, string beans, tea, bread, butter, choco- 
late, blanc mangue, coffee. 

Supper — Roast pork, baked potatoes, hominy, steamed bread, 
rolls, butter, tea, coffee, piccalilli, marmalade. 

THURSDAY: 

Breakfast — Force, milk, bread, butter, tea, coffee, toast, beefsteak, 

Mackerel, broiled, minced potatoes. 
Dinner — Corned beef, steamed potatoes, kraut, stewed tomatoes, 

bread, butter, peach pie, cheese, tea, coffee. 
Supper — Roast beef, gravy, fried onions, cubed potatoes, creamed, 

tea biscuits, bread, butter, tea, coffee, tomato preserves. 

FRIDAY: 

Breakfast — Puffed rice, milk, bread, butter, tea, coffee, toast, fried 

eggs, mashed potatoes. 
Dinner — Roast ribs of beef, brown gravy, browned potatoes, 

creamed carrots, stewed corn, pickles, bread, butter, cottage 

pudding, vanilla sauce, tea, coffee . 
Supper — Stewed oysters, oyster crackers, French fried potatoes, 

catsup, salmon, bread, butter, tea, coffee, canned cherries. 

SATURDAY: 

Breakfast — Rolled oats, milk, bread, butter, tea, coffee, fried 
sausage, buckwheat cakes. 
v Dinner — Pea soup, hot crackers, bread, butter, roast beef, gravy, 
tea, coffee, mashed potatoes, string beans, tapioca pudding with 
jelly. 

Supper — Cold beef, syrup, mush and milk, baked potatoes, mus- 
tard, pickles, bread, butter, bananas, tea, coffee. 

CHILDREN. 
SUNDAY: 

Breakfast — Oat meal, bread, butter, coffee. 

Dinner — Boiled beef, lima beans, piccalilli, dates, bread. 

Supper — Cake, cheese, syrup, bread, butter, tea. 

MONDAY: 

Breakfast — iGranulated hominy, milk, bread, butter, coffee. 
Dinner — Beef stew, macaroni and tomatoes, bread, apples. 
Supper — Stewed apples, ginger snaps, bread, butter, tea. 



106 

TUESDAY: 

Breakfast— Boiled rice, milk, bread, butter, coffee. 

Dinner — Beef stew, cubed creamed potatoes, bread, corn starch 

pudding. 
Supper — Ginger cake, dried apricots, bread, butter, tea. 

WEDNESDAY: 

Breakfast — Oat meal, milk, bread, butter, tea. 

Dinner — Navy bean soup, water crackers, bread turnips, bread 

pudding. 
Supper — Creamed hominy, bread, rolls, butter, tea. 

THURSDAY: 

Breakfast — Granulated hominy, milk, bread, butter, tea, 

Dinner — Boiled bacon, kraut, steamed potatoes, bread, tapioca and 

currant jelly. 
Supper — Dried peaches, bread, butter, tea. 

FRIDAY: 

Breakfast — Boiled rice, milk, bread, butter, tea. 
Dinner — Boiled pork, string beans, bread, apples. 
Supper — Mush, milk, bread, butter, tea, syrup. 

SATURDAY: 

Breakfast — Oat meal, milk, bread, butter, tea. 

Dinner — Pea soup, water crackers, bread, potatoes in jackets, rice 

pudding. 
Supper — Ginger bread, dried apples, bread, butter, tea. 



107 



WESTERN PENNSYLVANIA HOSPITAL, 



DEPARTMENT OF -THE INSANE. 



DIXMONT. 



The weekly bill of fare of this Institution is as follows: 

SUNDAY: 

Breakfast — Stewed veal, bread, butter, eggs, sugar, syrup, coffee. 
Dinner — Corned beef, potatoes, boiled cabbage, pies, bread, butter. 
Supper — Cold meat, tea, ginger bread, butter, cheese, sugar, syrup. 

MONDAY: 

Breakfast — Beefsteak, boiled potatoes, bread, butter, sugar, syrup, 

Coffee. 
Dinner — Boiled beef, vegetable soup, picalilli, bread puddings, 

bread, butter. 
Supper — Dried beef, corn bread, apple butter, bread, butter, sugar, 

syrup, tea. 

TUESDAY: 

Breakfast — Stewed veal, bread, butter, sugar, syrup, coffee. 
Dinner — Roast beef, hominy, boiled potatoes, pickles, bread, butter, 
Supper — Light cakes, stewed fruits, bread, butter, sugar, syrup, 
tea. 

WEDNESDAY: 

Breakfast — Beefsteak, fish, fried potatoes, bread, butter, sugar, 

syrup, coffee, 
Dinner — Roast veal, fresh pork, rice, green or dried corn in season, 

butter, bread. 
Supper — Cinnamon bread, cheese, bread, butter, sugar, syrup, tea. 

THURSDAY: 

Breakfast — Beefsteak, corn cakes, bread, butter, liver and fried 

onions, coffee. 
Dinner — Roast beef, potatoes, pickles, cold slaw, butter, bread. 
Supper — Mush and milk, stewed fruit, bread, butter, Biscuit, sugar, 

syrup, tea. 



108 : 

FRIDAY: 

Breakfast — Fish, meat stew, baked or boiled potatoes, bread, 

butter, sugar, syrup, coffee. 
Dinner — Roast mutton, boiled beans, rice pudding, fresh pork, 

bread, butter. 
Supper — Dried beef, crackers, bread, butter, sugar, syrup, tea. 

SATURDAY: 

Breakfast — Beefsteak, baked potatoes, bread, butter, sugar, syrup, 

coffee. 
Dinner — Roast beef, tomatoes, potatoes, stewed onions, bread, 

butter. 
Supper — iStewed fruit, crackers, bread, butter, baked apples, syrup, 

sugar, tea. 

ON HOLIDAYS. 

Turkey, oysters, cranberries, mince pies, fruit cakes, doughnuts, 
sweet potatoes, etc. 

INVALID DIET. 

Beef tea and essence, broths, toast, bread and milk, boiled milk, 
milk punch, jelly, eggs, brown bread, oat meal, gruel, corn starch, 
farina, tapioca, sago, chicken, etc., etc. 

Vegetables and fruits vary with the season; two kinds of fresh 
vegetables from the hospital farm are always served for dinner 
during the summer months, and dried, canned or preserved vege- 
tables and fruits are provided in the colder portions of the year. 
Additional variety is also afforded in relishes, sauces, butters, etc. 
In their season, melons, grapes, apples and small fruits grown upon 
our farm, are furnished in abundance. 



109 



PENNSYLVANIA TRAINING SCHOOL FOR 
FEEBLE-MINDED CHILDREN. 



ELWYN. 



The weekly bill of fare of this Institution is as follows: 

Saturday, January 19, 1907. 
BREAKFAST: 

Children — Fried and boiled eggs, butter, coffee. 
Specials* — Malta Vita, eggs, bread, butter, toast, cocoa. 
Attendants — Force, ham, potatoes, bread, butter, coffee. 
Officers — Hani, potatoes, shredded wheat, force, toast, coffee, 
bread, butter. 

DINNER: 

Children — Roast beef, potatoes, tomatoes, bread, butter, dates, 

tea. 
Specials — Potatoes, corn, bread, butter, dates, tea. 
Attendants — Corn beef, cabbage, potatoes, bread, butter, tea, 

apples. 
Officers' Lunch — Hamburg steak, potatoes, bread, butter, fruit, 

coffee. 

SUPPER: 

Children — Sweet potatoes, bread, butter, tea. 

Attendants — Beef steAv, cold slaw, bread, butter, cranberry sauce, 
tea. 

Officers' Dinner — Corn beef, roast beef, cabbage, potatoes, to- 
matoes, crackers, cheese, pies, coffee. 

Sunday, January 20, 1907. 
BREAKFAST: 

Children — Oat meal, sugar, bread, butter, coffee. 
Specials — Malta Vita, sugar, bread, butter, toast, cocoa, chipped 
beef. 



♦Those children whose appetites need stimulating. 



110 

Attendants — Oat meal chipped beef, potatoes, bread, butter, coffee. 
Officers — Oat meal, chipped beef, fried potatoes, bread, butter, 
coffee, force, shredded wheat. 

DINNER: 

Children — Baked beans, pickles, bread, butter, milk, bananas. 

Specials — Potatoes, tomatoes, bread, butter, milk, bananas. 

Attendants — Roast chicken, mashed potatoes, beans, bread, but- 
ter, coffee, bananas. 

Officers' Lunch — Cold meat, beans, potatoes, cold slaw, bread, but- 
ter, fruit, coffee. 

SUPPER: 

Children — Cake, coffee, bread, butter. 
Attendants — Cold meat, bread, butter, sauce, cake, tea. 
Officers' Dinner — Stewed chicken, potatoes, asparagus on toast, 
peas, cheese, crackers, salted nuts, ice cream, cake, coffee, celery. 

Monday, January 21, 1907. 
BREAKFAST: 

Children — Grits, sugar, bread, butter, coffee. 
Specials — Malta Vita, sugar, bread, butter, cocoa, toast. 
Attendants — Oat meal, steak, potatoes, bread, butter, coffee. 
Officers — Oat meal, steak, fried potatoes, bread, butter, coffee, 
force, shredded wheat, toast. 

DINNER: 

Children — Vegetable soup, potatoes, bread, butter, tea, cakes. 
Specials — Vegetable soup, potatoes, bread, butter, tea, cakes. 
Attendants — Roast beef, potatoes, bread, butter, tea, peas, rice 

pudding. 
Officers' Lunch — Corn beef hash, baked potatoes, biscuit, pickles, 

tea, fruit. 

SUPPER: 

Children — Cheese, crackers, bread, butter, tea. 
Attendants — Cold meat, stewed potatoes, bread, butter, sauce, tea. 
Officers' Dinner — Roast beef, potatoes, spinach, macaroni, cheese, 
crackers, fruit gelatine, coffee. 

Tuesday, January 22, 1907. 
BREAKFAST: 

Children — Farina, fried bread, butter, sugar, coffee. 



Ill 

Specials — Malta Vita, toast, potatoes, bread, butter, sugar, cocoa. 
Attendants — Mutton chops, potatoes, force, bread, butter, coffee. 
Officers — Steak, potatoes, oat meal, force, bread, butter, shredded 
wheat. 

DINNER: 

Children — Mutton stew, potatoes, bread, butter, milk, rice pudding. 
Specials — Parsnips, potatoes, bread, butter, milk, rice pudding. 
Attendants — Roast mutton, potatoes, parsnips, butter, tea, rice 

pudding. 
Officers' Lunch — Mutton stew, potatoes, corn bread, coffee, potato 

salad, apple tapioca. 

SUPPER: 

Children — Bread pudding, bread, butter, tea. 

Attendants — Mutton stew with potatoes, baked apples, bread, but- 
ter, tea. 

Officers'/ Dinner — Roast beef, mutton, potatoes, parsnips, tomatoes, 
crackers, cheese, nuts, cake, coffee. 

Wednesday, January 23, 1907. 
BREAKFAST: 

Children — Oat meal, fried bread, sugar, coffee, bread, butter. 
Specials — Malta Vita, sugar, potatoes, toast, cocoa, bread, butter. 
Attendants — Liver and bacon, potatoes, bread, butter, coffee, oat 

meal. 
Officers — Mutton chops, potatoes, bread, butter, coffee, shredded 

wheat, oat meal, toast. 

DINNER: 

Children — Roast beef, lima beans, potatoes, bread, butter, cheese, 

crackers, pudding. 
Specials — Soup, potatoes, bread, butter, tea, milk, crackers, cheese, 

pudding. 
Attendants — Roast beef, lima beans, potatoes, bread, butter, tea, 

mince pies. 
Officers' Lunch — Hamburg steak, browned potatoes, cheese straws, 

coffee, bread, butter, rice pudding. 

SUPPER: 

Children — Cake, bananas, bread, butter, tea. 

Attendants — Toast, cold meat, baked potatoes, pickles, tea, bread, 

butter, bananas, pudding. 
Officers' Dinner — Roast beef, potatoes, peas, lima beans, crackers, 

rolls, celery, bread, butter, coffee, marangues, cakes. 



112 

Thursday, January 24, 1907. 
BREAKFAST: 

Children — Fried bread, oat meal, sugar, bread, butter, coffee. 
Specials — Malta Vita, bread, butter, toast, mackerel, cocoa. 
Attendants — Oat meal eggs, potatoes, bread, butter, coffee. 
Officers — Oat meal, mackerel, eggs, potato cakes, toast, force, 
bread, butter, coffee. 

DINNER: 

Children — Veal -stew, turnips, bread filling, bread, butter, dates, 

milk. 
Specials — Bread filling, potatoes, bread, butter, milk, dates. 
Attendants — Roast veal, potatoes, tomatoes, bread, butter, lemon 

pies, tea. 
Officers' Lunch — Veal chops, potatoes, pickles, cakes, bread, butter, 

chocolate, tea. 

SUPPER: 

Children — Cake, tomato soup, bread, butter, coffee. 
Attendants — Beef pie, bread, butter, coffee cakes, sauce, tea. 
Officers' Dinner — Roast beef, veal, mashed potatoes, corn fritters, 
tomatoes, crackers, cheese, rolls, pies, coffee. 

Friday, January 25 1907. 
BREAKFAST: 

Children — Fried bread, Farina, sugar, bread, butter, coffee. 
Specials — 'Malta Vita, bread, butter, sugar, toast, potatoes, cocoa. 
Attendants — Oat meal, veal chops, potatoes, bread, butter, coffee. 
Officers — Oat meal, steak, toast, force, potatoes, bread, butter, 
coffee, shredded wheat. 

DINNER: 

Children — Cod fish, macaroni with tomatoes, bread, butter, milk, 
tea, pudding. 

Specials — Baked fish, mararoni with tomatoes, bread, butter, milk, 
tea, pudding. 

Attendants — Fried halibut, browned potatoes, peas, bread, but- 
ter, tea, cream puffs. 

Officers' Lunch — Fried halibut, potatoes, sauce, biscuit, baked 
apples, coffee. 

SUPPER: 

Children — Hot cakes, syrup, bread, butter, tea. 

Attendants — Oyster stew, eggs, crackers, bread, butter, apple 
sauce, coffee. 

Officers' Dinner — Oyster stew, roast beef, potatoes, puffs, aspara- 
gus on toast, corn, crackers, cheese, rolls, ice cream, cake, coffee. 



113 



PROPOSED ACTS OF ASSEMBLY. 



An act to provide for the protection of insane persons, feeble-minded 
persons and epileptics, and the appointment of a guardian for 
the said insane persons, feeble-minded persons and epileptics 
unable to care for their own property, authorizing the guardian 
to support the wife and children of the said insane persons, 
feeble-minded persons and epileptics, denning the powers of the 
guardian, and authorizing the sale of real estate of the ward. 

Section 1. Be it enacted, etc., that whenever hereafter any person 
being a resident of this 'State shall become insane or feeble-minded 
or 'epileptic, or so mentally defective that he or she is unable to take 
care of his or her property, and in consequence thereof is liable to 
dissipate or lose the same and to become the victim of designing 
persons, it shall be lawful for either the mother, father, brother, 
sister, husband, wife, child, next of kin, creditor, or in the absence of 
such person or persons or their inability, any other person to present 
to the Court of Common Pleas of the county in which said person to 
be cared for resides, his or her petition under oath, setting forth 
the facts, praying the Court to adjudge such person to be unable to 
take care of his or her property, and to appoint a guardian for the 
estate of such person. 

SECTION 2. Thereupon it shall be the duty of the Court to fix 
i day for the hearing on such application and direct that ten days' 
written notice thereof be given to the person against whom the 
petition is presented and also to the other members of his or her 
family residing within the jurisdiction, and if such person or persons 
cannot be found, then by notice by such publication as the Court 
may think proper. 

(SECTION 3. Upon the day fixed for the hearing the Court shall 
require the presence of the person against whom the petition is pre- 
sented unless there is positive testimony to the effect that such 
person cannot be brought into court with safety to him or herself. 
At such hearing the Court shall take the testimony of all the parties 
in interest and of such other witnesses as the petitioner and the 
person against whom proceedings are instituted, or any member of 
his or her family he or she may sec fit to summons on the question 
of the inability of the person against whom the proceedings are taken 
to care for his or her property because of mental deficiency. If the 
Court on such hearing shall be satisfied that the person against 
whom the proceedings are taken is not able owing to insanity or 

8 



U4 

weakness of mind to take care of his or her property, then it shall 
be the duty of the Court to decide and enter a decree accordingly 
and appoint a guardian to take care of the same. 

SECTION 4. If the person against whom the proceedings are 
taken shall demand in writing prior to the decision of the Court 
on such application a trial by jury, it shall thereupon be the duty 
of the said Court to award an issue framed to determine the question 
of fact involved, and such trial shall be granted. 

SECTION 5. From and after a degree that the person against 
whom same is entered is insane or so weak in mind that he or 
she is unable to take care of his or her property, the said person 
shall be wholly incapable of making any contract or gift whatever 
or any instrument in writing, and the entry of such decree shall 
be notice of such incapacity and said person shall be a ward of the 
Court appointing such guardian. 

SECTION 6. The guardian so appointed shall have precisely 
the same powers and be subject to the same duties as a Committee 
in Lunacy in the State of Pennsylvania; the Court appointing such 
guardian shall have full power over the same in directing an allow- 
ance for the said ward and for the support and maintenance of his 
wife, or his or her children, and the education of his or her minor 
children, and shall enter a decree of sale, mortgaging, leasing or 
conveyance upon ground rent of the real estate or any part thereof 
of the said ward, whenever in the opinion of the Court it is neces- 
sary for the support and maintenance of the said ward or his family 
or the education of his or her minor children or the payment of his 
or her debts, or where it is for the interest and advantage of the said 
ward that the same shall be sold, mortgaged, leased or let on ground 
rent, and all absolute sales in fee simple except as hereinafter pro- 
vided shall be by public sale or vendue and may be either entirely 
for cash, or partly on credit, and after full advertisement for at 
least twenty days, by hand bills posted in at least twenty of the 
most public places in the city or county where the said premises 
shall be situated, and in at least two newspapers not less than 
three times in each; provided, that if the Court shall be of the 
opinion that under the circumstances a better price can be obtained 
by private sale than at public sale, the Court may decree and ap- 
prove the same. Such sale, mortgaging, leasing and letting on 
ground rent shall be upon terms and rates to be approved by the 
Court. When the said real estate is situated in the same county 
in which the said person shall reside, or in another county or 
counties, and the Court shall be satisfied of the propriety of a 
sale, mortgaging or leasing or letting on ground rent upon such 
real estate or any part thereof not within their jurisdiction, it shall 
be lawful for such Court to make an order or decree authorizing 



115 

such guardian to sell, mortgage, lease or let upon ground rent all 
the real estate of the ward or so much thereof as the Court may 
think necessary and as it may designate; thereupon it shall be the 
duty of the Court of Common Pleas of the county wherein the real 
estate so designated is situated, upon the petition of such guardian, 
to make an order for the sale, mortgaging, leasing or letting upon 
ground rent of said real estate or so much thereof as the Court 
appointing said guardian by its 'order shall designate, and such 
guardian shall in all cases make a return of his proceedings to the 
said Court in the county in which the real estate was sold, mort- 
gaged, leased or let upon ground rent shall be found only if the 
same be approved by the Court, it shall be confirmed and said 
guardian shall make a return of said proceedings to the Court 
by which said guardian was appointed. The said guardian shall 
give such bonds and file such accounts at such periods as the Court 
shall determine. 

SECTION 7. If at any time after decree has been entered the 
person against whom such proceedings are taken shall become able 
to care for his or her property, he or she or any one of his or her 
family or next of kin may petition to the Court, setting forth such 
fact and after a hearing of which due notice shall be given to such 
person so afflicted and to all members of the family and next of kin 
of the said person, if the Court shall find that the said person so 
afflicted has regained the ability to care for his or her property 
the Court shall so decree and shall discharge the guardian and there- 
upon the said person shall be so far as the care of his or her property 
or persons shall be concerned for the future the same as if the pro- 
ceedings against him or her had never been taken. 

SECTION 8. Any person aggrieved, by the final decree of the 
Courts of Common Pleas may within three months from the time 
of the entry of said decree appeal to the Superior Court of the State 
and such Court may confirm, reverse or modify the decree entered 
in the lower Court. 

SECTION 9. All Acts or parts of Acts inconsistent herewith are 
and the same are hereby repealed. 



116 



An act to provide lor the commitment of insane persons to institu- 
tions wholly or in part maintained by the State, and for the 
transfer of insane persons from private institutions to State 
institutions, and prescribing a method by which the Court com- 
miting said insane person shall ascertain the responsibility of 
either the estate of the said insane person, if any, or the re- 
sponsibility of relatives of the said insane person, if any, to pay 
for the maintenance of the sam& and for the enforcement of 
said orders and the collection of moneys thereunder which may 
be ordered to be paid. 

SECTION 1. Be it enacted, etc., that from and after the pas- 
sage of this Act, before any person shall be committed to any iState 
institution for the care of the sane, whether or not the said person 
shall have previously been committed to a private institution for the 
care of the insane, a petition shall be presented to the Court of Quar- 
ter Sessions of the county or in Chambers wherein the said alleged 
insane person resides, which shall be signed and sworn to by the 
nearest relative or next of kin of the said person alleged to be in- 
sane, or in the absence of such relatives or next of kin, or inability 
of said relative or next of kin to make such petition, which shall 
appear affirmatively in the body of said petition, by some other per- 
son. Said petition shall set forth, first, the name, residence and 
nationality of the alleged insane person, whether the said alleged 
insane person is a citizen of this Commonwealth, and if so, how long; 
second, the name and address of the father, mother, husband, wife 
and children of the said alleged insane person, if any such exist, and 
if there be no such relatives; then the nearest relative or next of kin; 
third, an itemized statement of all the estate which the alleged in- 
sane person may possess or own, together with the name, residence, 
place of business of any fiduciary officer, trustee or other person who 
may have charge or care of the said estate or property; fourth, the 
name, residence and place of business *of any and all persons who may 
be liable under the law for the maintenance of the said alleged insane 
person, together with a detailed statement of the estate, property 
and financial ability of such person or persons who may become 
liable to pay for the maintenance of the alleged insane person. Said 
petition shall be accompanied by the affidavits of two competent 
practicing physicians of at least five years' standing setting forth 
the number of times they have visited and examined the alleged 
insane person and the duration of the same. 

SECTION 2. Upon the presentation of the said petition, the 
Judge to whom the petition is presented shall fix a time and place 



117 

for a hearing, and notice of the same shall be given the alleged in- 
sane person, the nearest relative and next of kin and to the County 
Commissioners, Department of Public Health and Charities or the 
proper poor authorities who might be charged with the maintenance 
of the alleged insane person as the case may be, or their attorneys; 
service of said notice shall be proved to the satisfaction of the Court 
before a hearing shall be proceeded with and at said hearing the 
alleged insane person shall be present, unless it shall appear from 
the testimony of at least two physicians who have examined the 
alleged insane person that it would be dangerous to the health 
or life of said alleged insane person or to others to thus produce 
him or her, together with the petitioner and at least one of the 
physicians certifying to the insanity of the alleged insane person, 
all of whom shall be examined by the Court or counsel for the par- 
ties, if such there may be or by the attorney for the proper au- 
thorities notified as hereinbefore provided, who shall have the right 
to examine said persons or witnesses on all matters pertaining to 
the estate of the alleged insane person, and the estate of all -per- 
sons who under the law might be chargeable with the maintenance 
of the alleged insane person. Any person or persons may be sum- 
moned before the Court and compelled to testify by subpoena is- 
sued by the said Court on all matters pertaining to the commitment 
of the alleged insane person and the maintenance of the alleged 
insane person, and if the Court shall find that said alleged in- 
sane person is insane, the said Court shall enter a decree setting 
forth that the said person is insane, and shall commit said person 
to a State Hospital or institution for the care and treatment of the 
insane, and shall make such order for the support and maintenance 
of the said insane person, not to exceed the per capita amount fixed 
by law, chargeable to the county wherein the said insane person 
had a residence or settlement, and the per capita amount charge- 
able by law against the Commonwealth for the care and maintenance 
of the said insane person against the estate of the said insane per- 
son or the person or persons who may be liable for the maintenance 
of the said insane person or both the estate of the said insane per- 
son and the person or persons who may be liable for the mainten- 
ance of the said insane person as the circumstances will admit, 
which said order shall be payable to the proper poor authorities, 
who shall be designated by the Court in the order made. 

SECTION 3. The said Court shall have the further power to order 
and direct that a bond shall be filed, which shall be approved by the 
Court to secure the payment of such order. 

SECTION 4. The County Commissioners, Department of Public 
Health and Charities and other authorities to whom orders for the 
support and maintenance of said insane persons are payable shall 



118 

keep a careful account of all moneys received by them under this 
Act, and shall make an annual report thereof to the Auditor-Gen- 
eral of the Commonwealth and shall make monthly returns to the 
County Treasurer of all money thus paid due the county and to the 
State Treasurer of all money due the State. 

SECTION 5. All persons who neglect or refuse to comply with 
any order made against them for the maintenance of any insane 
person committed under the provisions of this Act shall be liable 
to arrest on a warrant issued by the Court of Quarter Sessions of 
the county wherein the order was made, which shall issue the same 
upon an affidavit sworn and subscribed to before an officer qualified 
to administer oaths by any person familiar with the facts, setting 
forth that said person against whom such order was made is de- 
linquent and has failed to pay the same, whereupon a hearing shall 
be had, and if at the said hearing it appear to the Court that the 
person against whom the said order was made, is of ability to pay 
the said order and has refused and still refuses to comply with the 
said order, the Court shall have the power to commit such person 
to prison until such order is complied with or satisfactory arrange- 
ments have been made for the compliance with the same, or the 
Court in its discretion may deem wise to make. 

SECTION 6. All laws or parts of laws inconsistent with this 
Act are hereby repealed. 



119 



An Act to provide for the establishment of a Board of Public Chari- 
ties, prescribing the powers and duties of the said Board and 
defining their powers and duties and fixing their compensation 
and providing for their expenses. 

SECTION 1. Be it enacted, etc., That there be and is hereby 
established a Board of Public Charities to consist of a President, 
a Secretary and nine other citizens of this State who together 
shall constitute a Board of Public Charities of this Commonwealth. 
All of whom shall be appointed by the Governor by and with the 
advice and consent of the Senate. The persons so appointed be- 
fore entering upon the discharge of their duties shall respectively 
take and subscribe to the oath of office required of other State 
officers which shall be filed in the office of the Secretary of the Com- 
monwealth who is hereby authorized and directed to administer 
said oath. 

SECTION 2. The President of the said Board of Public Char- 
ities shall be appointed by the Governor by and with the advice 
and consent of the Senate for a term of four years and he shall be 
paid annually the sum of eight thousand dollars and his actual 
traveling expenses in the performance of his official duties. He shall 
be the presiding officer of the said board and shall have full control 
and management of all matters pertaining to the enforcement of 
the provisions of this act and shall have power to employ an at- 
torney at a yearly salary of not more than five thousand dollars 
who shall institute such proceedings by and on behalf of the said 
board as may be necessary to compensate and reimburse the Com- 
monwealth for the support and maintenance of all insane and other 
persons who shall be maintained and supported at the expense 
of the Commonwealth, and to perform such other legal duties 
as may be required by the said Board, to employ a stenographer at 
a salary of not more than one thousand dollars a year, and he may 
employ as many clerks, auditors and other employees as he may 
deem necessary and expedient to carry on the work of the said 
Board and the said clerks shall be paid a yearly salary to be fixed 
by the President and the said Board. After the organization of 
said Department the said Board shall make report to the Governor 
who shall transmit the same to the Legislature at its next regular 
session specifically setting forth the number and the salaries of the 
clerks and persons so employed. The President shall at least once 
in every year visit or cause to be visited by one or more of the em- 
ployees of his Department, all charitable, insane and correctional 



120 

institutions in this Commonwealth. He shall also at least once in 
every two years visit and examine into the condition of each of the 
State and County jails, prisons, insane institutions and alms and 
poor houses and all institutions within the Commonwealth that 
shall be maintained and supported by the State in whole or in 
part and report the result of such investigations and examinations 
into the conduct and management uf said institutions and the con- 
dition of all buildings, grounds and other property belonging to the 
same which said report shall be submitted to the Legislature of 
the Commonwealth at its regular session next ensuing. He shall 
receive all requests from institutions asking for State aid and upon 
receiving such request it shall be his duty to make careful inquiry 
into the same and report thereon and all other matters connected 
therewith annually to the Governor who shall submit the same to 
the next regular sessions of the Legislature. 

SECTION 3. The Governor shall be and with the advice and con- 
sent of the Senate appoint a Secretary of the Board of Public Char- 
ities who shall hold his office for a period of three years who shall 
be subject to removal upon cause by the Governor. He shall be a 
member of the Board ex officio and it shall be his duty subject to 
the control and direction of the said President and Board to keep 
a correct record of its proceedings, perform such clerical service as 
it may require, examine the returns of the several cities and coun- 
ties, wards, boroughs and townships in relation to the support of 
paupers therein, and in relation to births, deaths and marriages; 
and he shall prepare a series of interrogatories with the necessary 
accompanying blanks to the several institutions of charity, reform 
and correction in the State, and to those having charge of the poor 
in the several counties thereof, or any subdivision of the same, with 
a view to illustrate, in his annual report the causes and best treat- 
ment of pauperism, crime, disease and insanity. He shall also have 
printed and published in his said report all desirable information 
concerning the industrial and material interests of the Common- 
wealth bearing upon these subjects and shall have free access to 
all reports and returns now required by law to be made and he may 
also propose such general investigations as he may think best for 
the approval of the Board. He shall be paid annually the sum of 
$4,000 and his actual traveling expenses incurred while engaged 
in his official business. 

SECTION 4. The Governor by and with the advice and consent 
of the Senate shall appoint one of the persons constituting the Board 
of Charities for a period of one year, one for two years, one for three 
years, three for four years and three for five years unless they shall 
be sooner removed and any person who has been appointed a mem- 
ber of said Board of Public Charities who shall for a space of six 



121 

months refuse or neglect to discharge the duties of his office, and 
such failure having been duly certified by the President or Secretary 
of the said Board to the Governor, he shall be deemed to have re- 
signed and the Governor by and with the advice and consent of the 
Senate shall appoint a person to the said Board of Charities for the 
unexpired term of the person so removed, and in the event of any 
vacancy in the said Board caused by death, resignation or removal 
before the expiration of a term may be made for the residue of such 
term by the Governor subject to the consent of the Senate. The 
said persons constituting the said Board of Public Charities shall 
have full power at all times to examine into the condition of all 
the institutions hereinbefore named and examine into their methods 
of instruction, government and management of their inmates, the 
official conduct of trustees, directors and other officials and em- 
ployees of the same, the condition 01 the buildings and the method 
adopted in the construction of new buildings and the extent thereof, 
the grounds and other property connected therewith and into all 
other matters pertaining to their usefulness and good management, 
and ascertain whether the money appropriated for their aid are and 
have been economically and judicially expended, whether the objects 
of the several institutions are accomplished, whether the laws in 
relation to them are fully complied with, whether all parts of the 
State are equally benefitted by them and the various other matters 
referred to in this act benefitted by them and in their annual re- 
port to the Governor who shall transmit the same to the Legislature 
at its next regular session to embody the result of their investiga- 
tions together with such other information and recommendations as 
they may deem proper and for these purposes they shall have free 
access to the grounds, buildings and all books and papers relating to 
said institutions and all persons now or hereafter connected with the 
same are hereby directed and required to give such information and 
such other facilities for inspection as the said persons constituting 
the said Board may require any neglect or refusal on the part of 
any officer or person connected with such institution, to comply 
with any of the requirements of this Act, shall subject the offender 
to a penalty of one hundred dollars, to be sued for and collected 
by the President of the said Board in the name of the Board. 

SECTION 5. The said Board shall have power to suggest from 
time to time to the Trustees and Superintendent of the said insti- 
tutions such improvements in methods of construction, repairs and 
management as they may deem advisable and if the same shall not 
be adopted by said trustees and superintendents then said Board 
shall make a clear and concise statement of such facts in their an- 
nual report to the Governor of the Commonwealth together with 



122 

such, recommendations as they may deem advisable, who shall em- 
body the same in his message to the Legislature with his recom- 
mendations thereon. 

SECTION 6. In addition to the powers and duties herein con- 
ferred on said Board the said Board shall have authority to exercise 
all the powers and duties which the Board of Public Charities as 
now established possess. 

SECTION 7. The said Board of Public Charities shall have an 
office in the State Capitol and it shall be the duty of the Board of 
Commissioners of Public Grounds and Buildings to provide from 
time to time the necessary rooms, furniture, apparatus and supplies 
for the use of the said Board of Charities created under the provis- 
ions of this act. The said Board shall meet at least once in every 
three months, the time for such regular meetings to be fixed by 
the said Board. The President of the said Board shall call special 
meetings of the same whenever in his judgment he deems advisable. 
The members of the said Board of Charities other than the President 
and Secretary shall receive no compensation for their services, but 
their actual traveling and other necessary expenses shall be paid 
by the State Treasurer upon a certificate of the Auditor General. 

SECTION 8. The said Board of Public Charities shall have power 
to issue subpoenas to compel the attention of all witnesses that they 
may deem necessary to testify to any inquiries authorized by this 
Act and the several members of the said Board are each hereby au- 
thorized to administer oaths in examining any person or persons 
relative to any matters connected with inquiries authorized by this 
Act. 

SECTION 9. No member of the said Board of Public Charities 
shall be interested directly or indirectly in any contract for build- 
ing, repairing of furnishing any institution which by this Act they 
or any of them are authorized to visit or inspect, nor shall any trus- 
tee or other officer of any institution embraced in this act be eligible 
to be appointed a member of the said Board of Public Charities. 

SECTION 10. The said Board of Public Charities shall annually 
prepare and print and present annually to the Governor of the Com 
mon wealth, who shall transmit the same to the next biennial session 
of the Legislature, a full and complete report of all their doings 
during the year preceding stating fully in detail all expenses in- 
curred, showing the actual condition of all charitable and correct- 
ional institutions within the State with such suggestions as the 
Board may deem necessary and pertinent and the secretary is hereby 
authorized to prepare the necessary blanks and forward the same 
in good season to all institutions from whom information or re- 
turns may be needed, and to require a prompt return of the same 
with the blanks properly filled, and it shall also be the duty of the 



123 

President to prepare and have printed in the said annual report 
of the said Board a full and complete record of all his actions as 
President and of the said Board during the year preceding, stating 
fully in detail all expenses incurred of officers and agents employed 
and the number thereof, and a report of all applications received 
by him and recommendations made from institutions desiring State 
aid shall be made biannually to the Governor and by him shall be 
presented to the Legislature at their regular sessions. The Secretary 
of the said Board shall also prepare and have printed in his annual 
report and present the same to the Governor of the Commonwealth 
who shall transmit the same to the next regular session of the Leg- 
islature a full and complete record of all his actions as Secretary in 
the said Board which shall also embrace a record of the proceedings 
of the said Board. 

SECTION 11. It shall be the duty of the inspectors, sheriffs, keep- 
ers and other persons having charge of any penitentiary or jail 
within this Commonwealth and the records of the penitentiary or jail 
under their charge to fill out forms to be prepared for and fur- 
nished them by the said Board of Public Charities so that all in- 
formation and statistics which the said Board of Public Charities 
may deem necessary, may be presented with accuracy and uni- 
formity. 

SECTION 12. The amount of money to be expended under the 
provisions of this Act for the organization of this department, the 
employment of clerks, employees and other expenses shall not ex- 
ceed the sum of one hundred thousand dollars per annum. 

SECTION 13. All Acts or parts of Acts inconsistent herewith be 
and the same are hereby repealed. 



124 



AN ACT 

To provide for the employment of the insane, feeble-minded and 
epileptic persons confined in institutions wholly or in part main- 
tained by the State for the care and treatment of the insane, 
feeble-minded and epileptic persons, and providing for the dis- 
tribution of the supplies manufactured articles, goods and pro- 
ducts made in State institutions for the care of the insane, 
feeble-minded and epileptic persons. 

Whereas from the testimony taken by the Commission appointed 
by the Legislature of Pennsylvania, under a joint resolution, on the 
18th of April, 1905, entitled "A joint resolution creating a commis- 
sion to investigate various charitable institutions, etc.," for the in- 
vestigation of the management of State hospitals and institutions 
for the care and treatment of the insane, it appears that both the 
physical and mental condition of the inmates are improved when they 
are given employment ; and 

Whereas it also appears that some of those inmates who are given 
employment on the farms connected with the State institutions, and 
in and about the same, are much improved in body and mind; and 

Whereas it appears that the greater number of the inmates of the 
said institutions are, however, kept in idleness, because there is no 
employment that they can be given, 

It is therefore recommended by the Commission above mentioned, 
appointed by your honorable body, that means be divised whereby 
the inmates of the said institutions may be given employment and 
their condition thereby improved, and for that purpose the above 
mentioned Commission respectfully recommend the enactment by 
your honorable body of an Act entitled : 

SECTION 1. Be it enacted, etc., That from and after the passage 
of this Act all inmates of any institution or hospital which is wholly 
or in part maintained by the State, for the care and treatment of 
the insane, feeble-minded and epileptic persons may make, manu- 
facture or produce such supplies, manufactured articles, goods and 
products as may be used in any of the State hospitals or institu- 
tions. 

SECTION 2. All the supplies manufactured goods and products 
so made, manufactured or produced in institutions or hospitals shall 
bear the stamp giving the full name or title of the institution 
wherein said article was made, manufactured or produced. 

SECTION 3. Supplies, manufactured articles, goods and products 
so made, manufactured or produced shall not be sold or exchanged 



125 

to any person, firm, copartnership, unincorporated association or 
corporation, but same may be made subject to sale or exchange 
to any institution within the confines of the Commonwealth which 
is maintained by the State wholly or in part, wherein the insane, 
feeble-minded and epileptic persons are confined. 

SECTION 4. Any trustee, manager or superintendent or other 
person connected with the management and control of any institu- 
tion for the care and treatment of the insane, feeble-minded or epilep- 
tic, and who shall violate any of the provisions of this act by per- 
mitting any supplies, manufactured articles, goods or products to be 
sold or exchanged in any other way except as herein provided shall 
be guilty of a misdemeanor, and on conviction shall be sentenced 
to pay a fine of not more than five hundred dollars ($500.00) or either 
or both at the discretion of the Court. 

SECTION 5. All laws or parts of laws inconsistent herewith shall 
be and the same are repealed. 







1 1 Ap '08 



(126) 



